Provider Demographics
NPI:1306874284
Name:OVERTON, JAMES WHAREY SR (DENTIST)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WHAREY
Last Name:OVERTON
Suffix:SR
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3534
Mailing Address - Country:US
Mailing Address - Phone:910-350-0413
Mailing Address - Fax:910-350-2776
Practice Address - Street 1:6200 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3534
Practice Address - Country:US
Practice Address - Phone:910-350-0413
Practice Address - Fax:910-350-2776
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice