MEDICARE: THOMAS G. OVERMEYER D.D.S.

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

General Provider Information

NPI Number	:	1225121403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS G. OVERMEYER D.D.S.

Provider Business Mailing Address
First Line	:	3221 S CONWAY RD STE C
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7354
Country	:	US
Telephone Number	:	407-249-0808
Fax Number	:	407-658-4569

Provider Business Practice Location Address
First Line	:	3221 S CONWAY RD STE C
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7354
Country	:	US
Telephone Number	:	407-249-0808
Fax Number	:	407-658-4569

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. THOMAS G. OVERMEYER
Credential	:	DDS
Telephone Number	:	407-249-0808

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/25/2011

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