Provider Demographics
NPI:1407923691
Name:COOKE RICHARDSON & OVERSTREET DDS PC
Entity Type:Organization
Organization Name:COOKE RICHARDSON & OVERSTREET DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DOCTOR OF DENTAL SCIENCE
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-737-7402
Mailing Address - Street 1:39 W WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150
Mailing Address - Country:US
Mailing Address - Phone:804-737-7402
Mailing Address - Fax:804-737-5442
Practice Address - Street 1:39 W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150
Practice Address - Country:US
Practice Address - Phone:804-737-7402
Practice Address - Fax:804-737-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA983528OtherUNITED CONCORDIA