MEDICARE: DR. ROBERT F OVERCASH JR. 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	3816	NC

General Provider Information

NPI Number	:	1629071436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT F OVERCASH JR. DDS

Provider Business Mailing Address
First Line	:	229 N 1ST ST
Second Line	:	PO BOX 867
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-3902
Country	:	US
Telephone Number	:	704-982-5811
Fax Number	:	704-982-5686

Provider Business Practice Location Address
First Line	:	229 N 1ST ST
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-3902
Country	:	US
Telephone Number	:	704-982-5811
Fax Number	:	704-982-5686

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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