MEDICARE: DAVID L OVERBY DMD

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	DN013774	GA

General Provider Information

NPI Number	:	1841454774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L OVERBY DMD

Provider Business Mailing Address
First Line	:	2897 N DRUID HILLS RD NE
Second Line	:	BOX 119
City	:	ATLANTA
State	:	GA
Zip	:	30329-3924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2897 N DRUID HILLS RD NE
Second Line	:	BOX 119
City	:	ATLANTA
State	:	GA
Zip	:	30329-3924
Country	:	US
Telephone Number	:	678-427-0476
Fax Number	:

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

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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