Delores Mae O'Daniel, D.M.D., PLC

Key facts

NPI

1659434751

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

5608 (KY)

Practice address

1064 Brooks Hill Road
Suite a
Brooks, KY 40109-1063

Phone

(502) 955-1084

Fax

(502) 955-1442

NPI assigned

Dec 19, 2006

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other names

• Mrs. Delores Mae O'Daniel Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 16, 2015.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1659434751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1064 BROOKS HILL RD",
            "address_2": "SUITE A",
            "city": "BROOKS",
            "state": "KY",
            "postal_code": "401095149",
            "telephone_number": "502-955-1084",
            "fax_number": "502-955-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1064 BROOKS HILL ROAD",
            "address_2": "SUITE A",
            "city": "BROOKS",
            "state": "KY",
            "postal_code": "401091063",
            "telephone_number": "502-955-1084",
            "fax_number": "502-955-1442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DANIEL",
        "first_name": "DELORES",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "D.M.D., PLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DELORES",
            "last_name": "O'DANIEL",
            "middle_name": "MAE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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