Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22569 | TX |
NPI | 1003378779 |
---|---|
Provider Name | Dr. Yousef Odeh Jefferson |
First Address | Houston, TX 77021-5533 |
Second Address | Memphis, TN 38112-2957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | (05) | TN |