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General NPI Number Information
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NPI Number | 1861700205
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Entity Type | Individual
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Provider Name | EMERSON OVERSTREET
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Gender | Male
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 2800 WOODRUFF RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4806
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Country | US
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Telephone | 864-963-7000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN8639
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License Number State | SC
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