Healthcare Provider Details

I. General information

NPI: 1407923691
Provider Name (Legal Business Name): COOKE RICHARDSON & OVERSTREET DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 W WILLIAMSBURG RD
SANDSTON VA
23150
US

IV. Provider business mailing address

39 W WILLIAMSBURG RD
SANDSTON VA
23150
US

V. Phone/Fax

Practice location:
  • Phone: 804-737-7402
  • Fax: 804-737-5442
Mailing address:
  • Phone: 804-737-7402
  • Fax: 804-737-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS R OVERSTREET JR.
Title or Position: PARTNER DOCTOR OF DENTAL SCIENCE
Credential: DDS
Phone: 804-737-7402