Healthcare Provider Details

I. General information

NPI: 1609006865
Provider Name (Legal Business Name): BRUCE W. OVERTON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6037 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2160
US

IV. Provider business mailing address

6037 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2160
US

V. Phone/Fax

Practice location:
  • Phone: 804-744-3636
  • Fax: 804-744-6365
Mailing address:
  • Phone: 804-744-3636
  • Fax: 804-744-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE WAYNE OVERTON
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 804-744-3636