Provider Demographics
NPI:1649384934
Name:NORMAN, FORREST III (DDS)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:
Last Name:NORMAN
Suffix:III
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 1:200 QUEENS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3257
Mailing Address - Country:US
Mailing Address - Phone:704-334-5306
Mailing Address - Fax:
Practice Address - Street 1:200 QUEENS RD STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3257
Practice Address - Country:US
Practice Address - Phone:704-334-5306
Practice Address - Fax:888-272-2251
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9001QOtherBCBS ID NUMBER
NC5901345Medicaid