MEDICARE: DR. THOMAS G OVERMEYER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8947	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8947	OTHER	FL	DEPT OF PROF REG ST OF FL

General Provider Information

NPI Number	:	1104898741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS G OVERMEYER DDS

Provider Business Mailing Address
First Line	:	3221 S. CONWAY RD. SUITE C
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	407-249-0808
Fax Number	:	407-658-4569

Provider Business Practice Location Address
First Line	:	3221 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812
Country	:	US
Telephone Number	:	407-249-0808
Fax Number	:	407-658-5845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	12/30/2015

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