NPIMap

Organization Active NPI

Robert W Overdorf DDS, LTD

  • General Practice Dentistry
  • St Charles, IL
National Provider Identifier
1003959172
Registry record updated Dec 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.014949 Issued in IL
Legal business name
ROBERT W OVERDORF DDS, LTD
Practice address
11 S 2ND Ave
Suite 11
St Charles, IL 60174-1941
Phone
(630) 377-1200
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert W Overdorf, DDSNPI 1093051773
Title
President
Phone
(630) 377-1200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019.014949 IL Primary

Addresses

Primary practice location

11 S 2ND Ave
Suite 11
St Charles, IL 60174-1941

Mailing address

11 S 2ND Ave
Suite 11
St Charles, IL 60174-1941
Phone (630) 377-1200

National Provider Directory

National Provider Directory

Locations

11 S 2nd Ave
Ste 11
St Charles, IL 60174
Phone (630) 377-1200

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356566400000",
    "number": "1003959172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S 2ND AVE",
            "address_2": "SUITE 11",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741941",
            "telephone_number": "630-377-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S 2ND AVE",
            "address_2": "SUITE 11",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741941",
            "telephone_number": "630-377-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT W OVERDORF DDS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2012-12-27",
        "status": "A",
        "authorized_official_last_name": "OVERDORF",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-377-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.014949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.