Odoom, Phyllis A
Odoom, Phyllis A is an individual health care provider with primary practice located at 1 Shaws Cv , New London CT 06320-4902. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Odoom, Phyllis A can be contacted via phone (860) 447-8304.Contact Information
Primary practice address
1 Shaws Cv
New London CT 06320-4902
Phone: (860) 447-8304
Fax: (860) 443-8720
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 010355 | Connecticut |
Profile Details
| NPI number | 1205063674 |
|---|---|
| LBN Legal business name | Odoom, Phyllis A |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2009 |
| Last updated | Jan 19th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205063674 | NPPES |
| Connecticut | MEDICAID | 004236354 |
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