Provider Demographics
NPI:1174931430
Name:OVERBROOK FAMILY DENTISTRY
Entity type:Organization
Organization Name:OVERBROOK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-665-7311
Mailing Address - Street 1:306 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524-9747
Mailing Address - Country:US
Mailing Address - Phone:785-665-7311
Mailing Address - Fax:785-665-7126
Practice Address - Street 1:306 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OVERBROOK
Practice Address - State:KS
Practice Address - Zip Code:66524-9747
Practice Address - Country:US
Practice Address - Phone:785-665-7311
Practice Address - Fax:785-665-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty