Provider Demographics
NPI:1003959172
Name:ROBERT W OVERDORF DDS, LTD
Entity Type:Organization
Organization Name:ROBERT W OVERDORF DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:OVERDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-377-1200
Mailing Address - Street 1:11 S 2ND AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1941
Mailing Address - Country:US
Mailing Address - Phone:630-377-1200
Mailing Address - Fax:
Practice Address - Street 1:11 S 2ND AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1941
Practice Address - Country:US
Practice Address - Phone:630-377-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0149491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty