Provider Demographics
NPI:1821252297
Name:ADCOCK, CARMEN OVERSTREET (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:OVERSTREET
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5103
Mailing Address - Country:US
Mailing Address - Phone:601-442-0250
Mailing Address - Fax:601-442-2448
Practice Address - Street 1:125 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5103
Practice Address - Country:US
Practice Address - Phone:601-442-0250
Practice Address - Fax:601-442-2448
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS347208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist