Leonard R Odham Jr DDS PA

Primary specialty

DentistTaxonomy code 122300000X

License

4101 Issued in NC

Legal business name

LEONARD R ODHAM JR DDS PA

Practice address

16 Powell St
Fair Bluff, NC 28439

Phone

(910) 649-7222

Fax

(910) 649-7113

NPI assigned

Feb 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Leonard Russell Odham Jr., DDSNPI 1952662041

Title

Pres

Phone

(910) 649-1222

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leonard Russell Odham Jr., DDS

  • General Practice Dentistry
  • Fair Bluff, NC
  • NPI 1952662041
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1063556587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "FAIR BLUFF",
            "state": "NC",
            "postal_code": "28439",
            "telephone_number": "910-649-7222",
            "fax_number": "910-649-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 POWELL ST",
            "city": "FAIR BLUFF",
            "state": "NC",
            "postal_code": "28439",
            "telephone_number": "910-649-7222",
            "fax_number": "910-649-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEONARD R ODHAM JR DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "ODHAM",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "910-649-1222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "4101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8996472",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fair Bluff Medical Clinic PLLC
• Leah Jordan Floyd
• Angiala Mia Guilmette
• Hope Advancement Inc.
• Klaudia Kowalkowska
• Malarie Catherine McConnell
• James Hubert Meares Jr., RPH
• Morefamilysupportllc
• Kristin Nelson
• Leonard Russell Odham Jr., DDS

• Dentist in Fair Bluff, NC
• Providers in Fair Bluff, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.