Provider Demographics
NPI:1134450034
Name:CYNTHIA OVERHOLSER DDS
Entity type:Organization
Organization Name:CYNTHIA OVERHOLSER DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:OVERHOLSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-297-6438
Mailing Address - Street 1:103 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5940
Mailing Address - Country:US
Mailing Address - Phone:979-297-6438
Mailing Address - Fax:979-297-4644
Practice Address - Street 1:103 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5940
Practice Address - Country:US
Practice Address - Phone:979-297-6438
Practice Address - Fax:979-297-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19245261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental