1902395346 NPI number — NORMAN DENTAL GROUP LLC

Table of content: BRITTANY LEE GILL (NPI 1811538077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902395346 NPI number — NORMAN DENTAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN DENTAL GROUP LLC
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:
6
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:
1902395346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 PALMER CIR
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:
73069-6301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-801-3147
Provider Business Mailing Address Fax Number:
888-975-7437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2408 PALMER CIR
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:
73069-6301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-801-3147
Provider Business Practice Location Address Fax Number:
888-975-7437
Provider Enumeration Date:
05/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KIRKPATRICK
Authorized Official First Name:
DENAE
Authorized Official Middle Name:
MICAE
Authorized Official Title or Position:
CO - OWNER
Authorized Official Telephone Number:
405-209-7013

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5486 , 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: 1992065908 . This is a "NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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