Provider Demographics
NPI:1518171156
Name:CALWAY-FAGEN, NORMAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:J
Last Name:CALWAY-FAGEN
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 1:210 CANTRELL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2420
Mailing Address - Country:US
Mailing Address - Phone:615-297-0643
Mailing Address - Fax:
Practice Address - Street 1:108 HARDING PL
Practice Address - Street 2:SUITE 202
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-3704
Practice Address - Country:US
Practice Address - Phone:615-352-8696
Practice Address - Fax:615-352-7099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000023881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice