Provider Demographics
NPI:1326156324
Name:OVERBECK, CARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:
Last Name:OVERBECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7162
Mailing Address - Country:US
Mailing Address - Phone:941-488-8788
Mailing Address - Fax:941-488-5788
Practice Address - Street 1:1040 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7162
Practice Address - Country:US
Practice Address - Phone:941-488-8788
Practice Address - Fax:941-488-5788
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 100801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63329Medicare PIN
U20054Medicare UPIN