| Organization Name: | WILLIAM M ODOM, DDS,INC |
| NPI Number: | 1649679960 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM MARTIN ODOM (PRESIDENT/DOCTOR/PROVIDER) |
| Mailing Address: | 5256 S Mission Rd Suite 1101 Bonsall |
| State: | CA US |
| Postal Code: | 920033614 |
| Phone Number: | 7604537789 |
| Fax Number: | 7607296952 |
| NPI Enumeration Date: | 08/22/2014 |
| NPI Last Update Date: | 02/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 17850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |