Provider Demographics
NPI:1609006865
Name:BRUCE W. OVERTON DDS PC
Entity Type:Organization
Organization Name:BRUCE W. OVERTON DDS PC
Other - Org Name:DOMINION ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-744-3636
Mailing Address - Street 1:6037 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2160
Mailing Address - Country:US
Mailing Address - Phone:804-744-3636
Mailing Address - Fax:804-744-6365
Practice Address - Street 1:6037 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2160
Practice Address - Country:US
Practice Address - Phone:804-744-3636
Practice Address - Fax:804-744-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty