Provider Demographics
NPI:1316169360
Name:NORMAN H PROULX D.D.S.
Entity type:Organization
Organization Name:NORMAN H PROULX D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PROULX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-624-4313
Mailing Address - Street 1:1140 SOMERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2847
Mailing Address - Country:US
Mailing Address - Phone:603-624-4313
Mailing Address - Fax:603-624-1695
Practice Address - Street 1:1140 SOMERVILLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2847
Practice Address - Country:US
Practice Address - Phone:603-624-4313
Practice Address - Fax:603-624-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191443Medicaid