Provider Demographics
NPI:1447570718
Name:NORMAN, MATTHEW TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TAYLOR
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 1:2511 OAKCREST AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1936
Mailing Address - Country:US
Mailing Address - Phone:336-282-2120
Mailing Address - Fax:336-282-0657
Practice Address - Street 1:2511 OAKCREST AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1936
Practice Address - Country:US
Practice Address - Phone:336-282-2120
Practice Address - Fax:336-282-0657
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice