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Provider Information for 1174961841

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. BRIAN OVERMYER DDS

Gender: MALE

Individual NPI: 1174961841

Calendar   Last Updated:  2013-06-04
  Certification Date: 

Details

Name Value
NPI 1174961841
Enumeration Date 2013-06-04
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 284 MEMORIAL CT SUITE A
CRYSTAL LAKE, IL 60014-6231
United States

Phone: 815-477-3700 | Fax:
View Map External Link
Primary Practice Address 284 MEMORIAL CT SUITE A
CRYSTAL LAKE, IL 60014-6231
United States

Phone: 815-477-3700 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist IL 019022498