Provider Demographics
NPI:1558430215
Name:NORMAN, THOMAS AUGUSTUS (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:AUGUSTUS
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-0157
Mailing Address - Country:US
Mailing Address - Phone:662-628-5212
Mailing Address - Fax:
Practice Address - Street 1:112 WEST GAINES
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-0157
Practice Address - Country:US
Practice Address - Phone:662-628-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1018611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice