Provider Demographics
NPI:1700978772
Name:PERFECT CHOICE DENTAL, P.C.
Entity Type:Organization
Organization Name:PERFECT CHOICE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:OVERMYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-477-3700
Mailing Address - Street 1:284 MEMORIAL COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6231
Mailing Address - Country:US
Mailing Address - Phone:815-477-3700
Mailing Address - Fax:815-477-4806
Practice Address - Street 1:284 MEMORIAL COURT
Practice Address - Street 2:SUITE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6231
Practice Address - Country:US
Practice Address - Phone:815-477-3700
Practice Address - Fax:815-477-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty