Individual
DR. MARK LEE O'DELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7971 MAIN ST, BIRCH RUN, MI 48415-8001
(989) 624-9381
(989) 624-9353
Mailing address
9389 S BEYER RD, BIRCH RUN, MI 48415-8426
(989) 624-6009
(989) 624-9353
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11334
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2926589
—
MI
01
—
479934
UNITED CONCORDIA
MI
01
—
J113340
BC/BS OF MI
MI
Enumeration date
01/12/2006
Last updated
07/09/2007
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