Provider Demographics
NPI:1093051773
Name:OVERDORF, ROBERT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:OVERDORF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0149491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice