Provider Demographics
NPI:1306973490
Name:O'DONNELL, FREDERICK ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROBERT
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3605
Mailing Address - Country:US
Mailing Address - Phone:541-686-9740
Mailing Address - Fax:
Practice Address - Street 1:487 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3605
Practice Address - Country:US
Practice Address - Phone:541-686-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR51261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
709826OtherUNITED CONCORDIA