Individual
DR. LEONARD RUSSELL ODHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16 POWELL ST., FAIR BLUFF, NC 28439-0368
(910) 649-7222
(910) 649-7113
Mailing address
PO BOX 368, 16 POWELL ST., FAIR BLUFF, NC 28439-0368
(910) 649-7222
(910) 649-7113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4101
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8996472
—
NC
Enumeration date
06/05/2012
Last updated
06/05/2012
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