Provider Demographics
NPI:1851465637
Name:OVERSTREET, DOUGLAS R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:OVERSTREET
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 NUCKOIS RD
Mailing Address - Street 2:STE B
Mailing Address - City:GLENN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-270-7737
Mailing Address - Fax:804-270-7475
Practice Address - Street 1:11551 NUCKOIS RD
Practice Address - Street 2:STE B
Practice Address - City:GLENN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:804-270-7737
Practice Address - Fax:804-270-7475
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA07681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA723292OtherUNITED CONCORDIA
VA111846OtherANTHEM
VA9182626Medicare ID - Type Unspecified