Provider Demographics
NPI:1568659142
Name:NORBERG, GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:NORBERG
Suffix:
Gender:M
Credentials:DMD
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 409
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-0409
Mailing Address - Country:US
Mailing Address - Phone:607-345-3131
Mailing Address - Fax:
Practice Address - Street 1:3200 FRANKFORD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3217
Practice Address - Country:US
Practice Address - Phone:215-739-5600
Practice Address - Fax:215-739-5600
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048251122300000X, 1223G0001X
PADS031380L1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025877223Medicaid