Individual
DR. SCOT A O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
14362 W STATE HIGHWAY 29 STE 101, LIBERTY HILL, TX 78642-4902
(512) 548-5040
(512) 548-5040
Mailing address
14362 W STATE HIGHWAY 29 STE 101, LIBERTY HILL, TX 78642-4902
(512) 548-5040
(512) 548-5042
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
18824
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073631107
NPI
TX
01
—
1598833550
NPI- TYPE 1
TX
01
—
47-0853393
TAX ID
TX
Enumeration date
11/30/2006
Last updated
11/10/2022
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