Provider Demographics
NPI:1578801379
Name:OVERTON AND JOH D.D.S., P.A.
Entity Type:Organization
Organization Name:OVERTON AND JOH D.D.S., P.A.
Other - Org Name:COLUMBUS SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-619-1962
Mailing Address - Street 1:407 N CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-2725
Mailing Address - Country:US
Mailing Address - Phone:910-619-1962
Mailing Address - Fax:
Practice Address - Street 1:25805 ANDREW JACKSON HWY E
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-8916
Practice Address - Country:US
Practice Address - Phone:910-655-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC86881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty