Provider Demographics
NPI:1366468878
Name:OVERBECK, MICHAEL JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:OVERBECK
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 1:427 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1027
Mailing Address - Country:US
Mailing Address - Phone:617-223-3243
Mailing Address - Fax:617-223-3038
Practice Address - Street 1:427 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1027
Practice Address - Country:US
Practice Address - Phone:617-223-3243
Practice Address - Fax:617-223-3038
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12142122300000X
MA21771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist