Provider Demographics
NPI:1124102215
Name:NORMAN, CARL PATTERSON (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:PATTERSON
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200429
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-9429
Mailing Address - Country:US
Mailing Address - Phone:216-921-4900
Mailing Address - Fax:216-921-3809
Practice Address - Street 1:11900 SHAKER BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1925
Practice Address - Country:US
Practice Address - Phone:216-921-4900
Practice Address - Fax:216-921-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300145441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice