Provider Demographics
NPI:1437173192
Name:NORWICK, KENNETH A (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:NORWICK
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23851 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1287
Mailing Address - Country:US
Mailing Address - Phone:313-274-4800
Mailing Address - Fax:313-274-5783
Practice Address - Street 1:23851 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1287
Practice Address - Country:US
Practice Address - Phone:313-274-4800
Practice Address - Fax:313-274-5783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI166411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics