Provider Demographics
NPI:1275626087
Name:NORMAN, DEVIN O'REILLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:O'REILLY
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 1:519 ADA DR SE STE A
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9069
Mailing Address - Country:US
Mailing Address - Phone:616-676-1977
Mailing Address - Fax:616-676-8836
Practice Address - Street 1:519 ADA DR SE STE A
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9069
Practice Address - Country:US
Practice Address - Phone:616-676-9177
Practice Address - Fax:616-676-8836
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist