Provider Demographics
NPI:1699865774
Name:NORMAN, DOUGLAS CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CRAIG
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12637 HESPERIA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7774
Mailing Address - Country:US
Mailing Address - Phone:760-243-5622
Mailing Address - Fax:760-243-1558
Practice Address - Street 1:12637 HESPERIA RD
Practice Address - Street 2:SUITE C
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7774
Practice Address - Country:US
Practice Address - Phone:760-243-5622
Practice Address - Fax:760-243-1558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0271801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics