Van S O'Dell, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2103 Issued in AR

Practice address

2501 Crestwood Rd
Ste 201
N Little Rock, AR 72116-6864

Phone

(501) 758-5006

Fax

(501) 758-2173

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chase C. Diemer DDS PLLC

  • Dental Clinic/Center
  • North Little Rock, AR
  • NPI 1265081509
  NPD (past)
• Dr. Kerry Moon, D.D.S., PLLC

  • Dental Clinic/Center
  • North Little Rock, AR
  • NPI 1013658681
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295845139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 CRESTWOOD RD STE 201",
            "city": "N LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167616",
            "telephone_number": "501-758-5006",
            "fax_number": "501-758-2173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 CRESTWOOD RD",
            "address_2": "STE 201",
            "city": "N LITTLE ROCK",
            "state": "AR",
            "postal_code": "721166864",
            "telephone_number": "501-758-5006",
            "fax_number": "501-758-2173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DELL",
        "first_name": "VAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "2103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Muhammad Ali Siddiqui, MD PA
• Nash Therapeutic Services, LLC
• North Little Rock Pet Associates, LLC
• North Little Rock Primary Care and Diagnostic Clinic PLLC
• North LR Medical Imaging LLC
• Stephanie Rebekah Oldham, MS, OTR/L
• Anthony P Owen, PHARMD
• Pain & Ortho Products, LLC
• Nancy Elaine Patterson, CCC-SLP
• Kandyse Payne, CNA

• All providers in N Little Rock, AR
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.