EAST NORMAN DENTAL

Provider Demographics

• NPI: 1790942431
• Name: EAST NORMAN DENTAL
• Entity Type: Organization
• Organization Name: EAST NORMAN DENTAL
• Authorized Official - Title/Position: DENTIST
• Authorized Official - First Name: LARRY
• Authorized Official - Last Name: LAVELETT
• Authorized Official - Credentials: DDS
• Authorized Official - Phone: 405-360-0018
• Mailing Address - Street 1: 443 12TH AVE NE
• Mailing Address - City: NORMAN
• Mailing Address - State: OK
• Mailing Address - Zip Code: 73071-5241
• Mailing Address - Country: US
• Mailing Address - Phone: 405-360-0018
• Mailing Address - Fax: 405-360-1178
• Practice Address - Street 1: 443 12TH AVE NE
• Practice Address - City: NORMAN
• Practice Address - State: OK
• Practice Address - Zip Code: 73071-5241
• Practice Address - Country: US
• Practice Address - Phone: 405-360-0018
• Practice Address - Fax: 405-360-1178
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-05-20
• Last Update Date: 2008-05-20

Provider Licenses

State	License ID	Taxonomies
OK	4835	1223G0001X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	1223G0001X	Dental Providers	Dentist	General Practice	Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	4835	Other	APWU
	4835	Other	BCBS OF ALABAMA
	4835	Other	DELTA DENTAL USA
	4835	Other	MUTUAL ASSURANCE
	4835	Other	HARRINGTON BENEFIT SERVICES
	4835	Other	UNICARE
	4835	Other	METLIFE
	4835	Other	MAILHANDLERS
	4835	Other	AMERICAN HEALTH GROUP, INC.
	4835	Other	QUADMED
	4835	Other	DELTA DENTAL OF ILLINOIS
	4835	Other	UNITED MEDICAL RESOURCES
	4835	Other	FMH
	4835	Other	BCBS
	4835	Other	CSCS
	4835	Other	AETNA
	4835	Other	DELTA DENTAL OF MISSOURI
	4835	Other	BROKERS NATIONAL LIFE
	4835	Other	DELTA DENTAL OF CALIFORNIA
	4835	Other	DELTA DENTAL
	4835	Other	NTCA
	4835	Other	PRINCIPAL
	4835	Other	OSMA
	4835	Other	UNITED HEALTHCARE
	4835	Other	JEFFERSON PILOT
	4835	Other	GEHA
	4835	Other	KEMPTON GROUP ADMIN, INC.
	4835	Other	WASHINGTON DENTAL SERVICES
	4835	Other	FORTIS
	4835	Other	CIGNA
	4835	Other	BCBS FEDERAL
	4835	Other	TRISURANT
	4835	Other	UNITED CONCORDIA
	4835	Other	DELTA DENTAL OF NEW JERSEY
	4835	Other	AIG
	4835	Other	GREAT CORNERSTONE
	4835	Other	BCBS OF TEXAS
	4835	Other	DELTA DENTAL OF ARKANSAS
	4835	Other	HUMANA DENTAL
	4835	Other	AMERITAS
	4835	Other	CENTRAL STATES FUNDS
	4835	Other	ASSURANT
	4835	Other	GUARDIAN
	4835	Other	DELTA DENTAL OF COLORADO
	4835	Other	BCBS OF ILLINOIS
	4835	Other	WATERSTONE
	4835	Other	BENEFIT PLANNERS
	4835	Other	DELTA DENTAL OF RI
	4835	Other	EMPLOYERS GROUP INSURANCE
	4835	Other	DELTA DENTAL OF PA