1417361205 NPI number — NORMAN DENTISTRY & BRACES

Table of content: (NPI 1417361205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417361205 NPI number — NORMAN DENTISTRY & BRACES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN DENTISTRY & BRACES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417361205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 SOUTH UNIVERSITY BOULDEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 S UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73069-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-321-6564
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCNAMARA
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
405-321-6564

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6595 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891108247 . This is a "NPPES" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".