Provider Demographics
NPI:1598817173
Name:OVERTURFF, CLYDE DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:DANIEL
Last Name:OVERTURFF
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 1:204 N ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060
Mailing Address - Country:US
Mailing Address - Phone:563-652-2553
Mailing Address - Fax:563-652-9816
Practice Address - Street 1:204 N ARCADE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060
Practice Address - Country:US
Practice Address - Phone:563-652-2553
Practice Address - Fax:563-652-9816
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0155549Medicaid