Active NPI
Clyde Daniel Overturff, DDS
- General Practice Dentistry
- Maquoketa, IA
National Provider Identifier
1598817173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 06334
- Practice address
- 204 N Arcade St
Maquoketa, IA 52060 - Phone
- (563) 652-2553
- Fax
- (563) 652-9816
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 06334 | IA | Primary |
Addresses
Primary practice location
204 N Arcade St
Maquoketa, IA 52060
Mailing address
204 N Arcade St
Maquoketa, IA 52060
Phone (563) 652-2553
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0155549 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06334 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1598817173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 N ARCADE ST",
"city": "MAQUOKETA",
"state": "IA",
"postal_code": "52060",
"telephone_number": "563-652-2553",
"fax_number": "563-652-9816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 N ARCADE ST",
"city": "MAQUOKETA",
"state": "IA",
"postal_code": "52060",
"telephone_number": "563-652-2553",
"fax_number": "563-652-9816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OVERTURFF",
"first_name": "CLYDE",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "06334",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0155549",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maquoketa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.