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NPI Code Detail

MEDICARE: DR. BENJAMIN THOMAS OVERSTREET D.D.S., M.S.

MEDICARE: DR. BENJAMIN THOMAS OVERSTREET D.D.S., M.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
11223P0300XPeriodontics04014110210VA

General Provider Information

NPI Number : 1689910101
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN THOMAS OVERSTREET D.D.S., M.S.
Provider Business Mailing Address
First Line : 4909 GROVE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23226-1649
Country : US
Telephone Number : 804-355-6593
Fax Number : 804-358-6394
Provider Business Practice Location Address
First Line : 4909 GROVE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23226-1649
Country : US
Telephone Number : 804-355-6593
Fax Number : 804-358-6394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2013
Last Update Date : 01/03/2013

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