MEDICARE: EMERSON OVERSTREET

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	DEN8639	SC

General Provider Information

NPI Number	:	1861700205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMERSON OVERSTREET

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 WOODRUFF RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-4806
Country	:	US
Telephone Number	:	864-963-7000
Fax Number	:

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

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	01/13/2026

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Directions to “ EMERSON OVERSTREET ” Practice Location

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