Provider Demographics
NPI:1790872588
Name:NORMAN, KEILA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEILA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HEMPSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6248
Mailing Address - Country:US
Mailing Address - Phone:860-443-2428
Mailing Address - Fax:800-583-0877
Practice Address - Street 1:190 HEMPSTEAD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6248
Practice Address - Country:US
Practice Address - Phone:860-443-2428
Practice Address - Fax:800-583-0877
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16339122300000X
CT101501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist