Provider Demographics
NPI:1689720732
Name:NORMAN, EDWARD MINOR (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MINOR
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 1:810 N. U.S. HWY. 63
Mailing Address - Street 2:211 WEST MADISON
Mailing Address - City:LANCASTER
Mailing Address - State:MO
Mailing Address - Zip Code:63548-9710
Mailing Address - Country:US
Mailing Address - Phone:660-457-2010
Mailing Address - Fax:
Practice Address - Street 1:810 N. US HWY 63
Practice Address - Street 2:RT 1 BOX 53
Practice Address - City:LANCASTER
Practice Address - State:MO
Practice Address - Zip Code:63548-9710
Practice Address - Country:US
Practice Address - Phone:660-457-3235
Practice Address - Fax:660-457-2110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402255806Medicaid