Provider Demographics
NPI:1356501928
Name:NORMAN PERIODONTICS & DENTAL IMPLANTS, PC
Entity Type:Organization
Organization Name:NORMAN PERIODONTICS & DENTAL IMPLANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:RENFROW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-329-6106
Mailing Address - Street 1:707 24TH AVE SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 24TH AVE SW
Practice Address - Street 2:SUITE 202
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3987
Practice Address - Country:US
Practice Address - Phone:405-329-6106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty