Active NPI
Elise Odom, R.D.A
- Dental Assistant
- Harlingen, TX
National Provider Identifier
1194256115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 35682
- Practice address
- 2701 S 77 Sunshinestrip
Harlingen, TX 78550-8318 - Phone
- (956) 430-9355
- Fax
- (956) 430-9373
- NPI assigned
- Mar 22, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 35682 | TX | Primary |
Addresses
Primary practice location
2701 S 77 Sunshinestrip
Harlingen, TX 78550-8318
Mailing address
105 Dickey St
Fort Polk, LA 71459-3546
Phone (956) 430-9355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35682 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1194256115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 DICKEY ST",
"city": "FORT POLK",
"state": "LA",
"postal_code": "714593546",
"telephone_number": "956-430-9355",
"fax_number": "956-430-9373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 S 77 SUNSHINESTRIP",
"city": "HARLINGEN",
"state": "TX",
"postal_code": "785508318",
"telephone_number": "956-430-9355",
"fax_number": "956-430-9373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "ELISE",
"credential": "R.D.A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-22",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "TX",
"license": "35682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harlingen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.