Individual
DR. WILLIAM S ODOM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
424 9TH ST, SUITE #1, COLUMBUS, GA 31901-2895
(706) 327-9936
Mailing address
424 9TH ST, SUITE #1, COLUMBUS, GA 31901-2895
(706) 327-9936
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10277
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00318029A
—
GA
01
—
100661
PEACHSTATE-AVESIS
—
01
—
820713
UNITED CONCORDIA
—
01
—
9181476
WELLCARE-DORAL
—
Enumeration date
07/16/2005
Last updated
12/17/2014
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