Provider Demographics
NPI:1356421994
Name:OVERBY, ERIC RICHARD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:OVERBY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2505
Mailing Address - Country:US
Mailing Address - Phone:507-437-3269
Mailing Address - Fax:507-437-6490
Practice Address - Street 1:700 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2505
Practice Address - Country:US
Practice Address - Phone:507-437-3269
Practice Address - Fax:507-437-6490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics