Provider Demographics
NPI:1851852016
Name:NORTON, GREGORY SCOTT
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:NORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 17TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2519
Mailing Address - Country:US
Mailing Address - Phone:561-278-0362
Mailing Address - Fax:
Practice Address - Street 1:900 NW 17TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2519
Practice Address - Country:US
Practice Address - Phone:561-278-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018.002100122300000X
390200000X
FLDN24624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program