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

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5608 Issued in 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

Last updated

Mar 16, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Delores Mae O'Daniel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "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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• General Practice Dentistry in Brooks, KY
• Providers in Brooks, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; 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.