MEDICARE: THOMAS F. OVERTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7176	CO

General Provider Information

NPI Number	:	1083883532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS F. OVERTON DDS

Provider Business Mailing Address
First Line	:	1220 OAK PARK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7302
Country	:	US
Telephone Number	:	970-223-6677
Fax Number	:	970-207-4013

Provider Business Practice Location Address
First Line	:	1220 OAK PARK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7302
Country	:	US
Telephone Number	:	970-223-6677
Fax Number	:	970-207-4013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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