Provider Demographics
NPI:1477679322
Name:FREDERICK J. NORFOLK, DMD, LLC
Entity Type:Organization
Organization Name:FREDERICK J. NORFOLK, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORFOLK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-478-7925
Mailing Address - Street 1:116 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-478-7925
Mailing Address - Fax:508-478-4069
Practice Address - Street 1:116 WATER STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-479-4925
Practice Address - Fax:508-478-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11093OtherBCBS PROVIDER ID NO.
MA1563OtherDELTA DENTAL PROVIDER NO.