Provider Demographics
NPI:1831295369
Name:BETTS, NORMAN J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:J
Last Name:BETTS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 OAK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2220
Mailing Address - Country:US
Mailing Address - Phone:734-769-1454
Mailing Address - Fax:
Practice Address - Street 1:9416 S MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4157
Practice Address - Country:US
Practice Address - Phone:734-455-0710
Practice Address - Fax:734-455-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014383204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI97OH28051OtherBCBSM PRACTICE ID
MINB014383OtherLICENSE #
MI97OH28051OtherBCBSM PRACTICE ID
MIU13203Medicare UPIN