Healthcare Provider Details

I. General information

NPI: 1962561209
Provider Name (Legal Business Name): JOHN A OVERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MS. SHERRIE L EBERG-FREEMAN

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E 98TH ST STE 241
INDIANAPOLIS IN
46280-2907
US

IV. Provider business mailing address

3003 E 98TH ST STE 241
INDIANAPOLIS IN
46280-2907
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-5894
  • Fax: 317-846-5986
Mailing address:
  • Phone: 317-846-5894
  • Fax: 317-846-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6973
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: