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General NPI Number Information
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NPI Number | 1275914848
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Entity Type | Organization
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Legal Business Name | SCOTT OVERHOLSER, DDS P.C.
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 3115 N BROADWAY
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City | CHICAGO
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State | IL
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Zip | 60657
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Country | US
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Telephone | 773-270-5000
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Fax | 872-206-5337
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Provider Business Mailing Address
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Address Line | 3115 N BROADWAY
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City | CHICAGO
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State | IL
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Zip | 60657
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Country | US
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Telephone | 773-270-5000
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Fax | 872-206-5337
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. SCOTT WILLIAM OVERHOLSER
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Credential | DDS
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Telephone | 773-270-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019026260
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License Number State | IL
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