Gary Odasso, DMD
Individual provider Active NPI General Practice Dentistry · Cuba, NM
NPI 1023066933 · NPPES record last updated May 8, 2014
Key facts
- NPI
- 1023066933
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD2618 (NM)
- Practice address
- 6349 US Highway 550
Presbyterian Medical Services
Cuba, NM 87013-0000 - Phone
- (575) 289-3291
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180219000332 | NM | Practitioner - Dentist | 6901166438 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD2618 | NM | MD | General Practice Dentistry |
Practice roles (2 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Centro Family Health | Current |
Accepting new patients | |
| El Centro Family Health | Past | Accepting new patients |
Locations
1235 8th St
Las Vegas, NM 87701
Phone (505) 425-6751
Networks
- CO HMO D-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD2618 | NM | Yes |
Addresses
Primary practice location
6349 US Highway 550
Presbyterian Medical Services
Cuba, NM 87013-0000
Mailing address
6349 US Highway 550
Presbyterian Medical Services
Cuba, NM 87013-0000
Phone (575) 289-3291
Other providers in Cuba, NM
- Richard Lande Kozoll
- Hilma M Lewis
- Mark Nienhuis
- Suzanne Elaine Norman
- Lille K. Norstad
- Karen Ojeda
- Julie Marie Pederson
- Chad Sinclair Pfeiffer
- Presbyterian Medical Services
- Presbyterian Medical Services
All providers in Cuba, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.