East Odessa Dental and Orthodontics PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

EAST ODESSA DENTAL AND ORTHODONTICS PLLC

Doing business as

Bliss Dental and Orthodontics

Practice address

4901 E 42ND St SPC B
Odessa, TX 79762-7241

Phone

(972) 869-3789

NPI assigned

Sep 21, 2016

Organization subpart

No

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

Authorized official

Name

Mary Pu

Title

VP of Finance

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Bliss Dental and Orthodontics Doing business as

Locations

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1588112338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734753",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734753",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 E 42ND ST SPC B",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627241",
            "telephone_number": "972-869-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ODESSA DENTAL AND ORTHODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "PU",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bliss Dental and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bliss Dental and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyle Stephen Dunaway, CRNA
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• Dentist in Odessa, TX
• Providers in Odessa, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; 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.