Active NPI
Sean Kyle Odenwalder, DMD
- Dentist
- Oceanside, CA
National Provider Identifier
1538416441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS10299
- Practice address
- 3935 Mission Ave Ste 9
Oceanside, CA 92058-7802 - Phone
- (760) 439-5515
- NPI assigned
- Aug 9, 2012
- Last updated
- Apr 11, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS10299 | CA | Primary |
| Dentist | 122300000X | 8352806-9922 | UT |
Addresses
Primary practice location
3935 Mission Ave Ste 9
Oceanside, CA 92058-7802
Mailing address
3935 Mission Ave Ste 9
Oceanside, CA 92058-7802
Phone (760) 439-5515
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 |
|---|---|---|---|
| DDS10299 | CA | MD | Dentist |
| 8352806-9922 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Odenwalder Dental Inc | Dentist | Past | Accepting new patients |
| Roger P. Moynihan and Amy Jessel Moynihan | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba MIssion Family Dentistry
- General Practice Dentistry
- Oceanside, CA
- NPI 1801945779
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523404800000",
"number": "1538416441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3935 MISSION AVE STE 9",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920587802",
"telephone_number": "760-439-5515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3935 MISSION AVE STE 9",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920587802",
"telephone_number": "760-439-5515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODENWALDER",
"first_name": "SEAN",
"middle_name": "KYLE",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-09",
"last_updated": "2018-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS10299",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "8352806-9922",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.