NPIMap

Organization Active NPI

Lizzie O'Dell PLLC

Doing business as Creative Pediatric Dentistry

  • Pediatric Dentistry
  • Hurricane, WV
National Provider Identifier
1073987038
Registry record updated Nov 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4042 Issued in WV
Legal business name
LIZZIE O'DELL PLLC
Doing business as
Creative Pediatric Dentistry
Practice address
3520 Teays Valley Rd
Hurricane, WV 25526-9479
Phone
(334) 538-1390
NPI assigned
Nov 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2015

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

Authorized official

Name
Elizabeth Pham O'Dell, DMD
Title
Owner
Phone
(334) 538-1390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 4042 WV Primary

Addresses

Primary practice location

3520 Teays Valley Rd
Hurricane, WV 25526-9479

Mailing address

3520 Teays Valley Rd
Hurricane, WV 25526-9479
Phone (334) 538-1390

Other names 1

  • Creative Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447372800000",
    "number": "1073987038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 TEAYS VALLEY RD",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269479",
            "telephone_number": "334-538-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 TEAYS VALLEY RD",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269479",
            "telephone_number": "334-538-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIZZIE O'DELL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-13",
        "last_updated": "2015-11-13",
        "status": "A",
        "authorized_official_last_name": "O'DELL",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "PHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-538-1390",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WV",
            "license": "4042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creative Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hurricane, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; 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.