Individual
DR. PHYLLIS A ODOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 447-8304
(860) 443-8720
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
010355
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236354
—
CT
Enumeration date
06/12/2009
Last updated
01/19/2011
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