Provider Demographics
NPI:1780857078
Name:NORMAN, JOSEPH ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALAN
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 1:1160 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-7735
Mailing Address - Country:US
Mailing Address - Phone:812-284-4040
Mailing Address - Fax:
Practice Address - Street 1:1160 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-7735
Practice Address - Country:US
Practice Address - Phone:812-284-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3351223S0112X
NC8542122300000X
TX262151223G0001X
TNDS00000101891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2188930-02Medicaid
NC5911732Medicaid
TX2188930-04Medicaid
TX2188930-03Medicaid
TX2188930-05Medicaid
TX2188930-01Medicaid