Provider Demographics
NPI:1962540328
Name:EDWARD M NORMAN DDS PC
Entity type:Organization
Organization Name:EDWARD M NORMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MINOR
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-457-3235
Mailing Address - Street 1:810 N. U.S. HWY. 63
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MO
Mailing Address - Zip Code:63548-9710
Mailing Address - Country:US
Mailing Address - Phone:660-457-3235
Mailing Address - Fax:660-457-2110
Practice Address - Street 1:US HWY 63 N
Practice Address - Street 2:RT 1 BOX 53
Practice Address - City:LANCASTER
Practice Address - State:MO
Practice Address - Zip Code:63548-9710
Practice Address - Country:US
Practice Address - Phone:660-457-3235
Practice Address - Fax:660-457-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty