Provider Demographics
NPI:1407905110
Name:NORMAN, CHARLES GODFREY II (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GODFREY
Last Name:NORMAN
Suffix:II
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 1:6800 NEWARK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-9656
Mailing Address - Country:US
Mailing Address - Phone:810-721-7453
Mailing Address - Fax:
Practice Address - Street 1:6800 NEWARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-9656
Practice Address - Country:US
Practice Address - Phone:810-721-7453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010175201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice