Provider Demographics
NPI:1902395346
Name:NORMAN DENTAL GROUP LLC
Entity Type:Organization
Organization Name:NORMAN DENTAL GROUP LLC
Other - Org Name:DK DENTAL AND COPELIN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENAE
Authorized Official - Middle Name:MICAE
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-209-7013
Mailing Address - Street 1:2408 PALMER CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6301
Mailing Address - Country:US
Mailing Address - Phone:405-801-3147
Mailing Address - Fax:888-975-7437
Practice Address - Street 1:2408 PALMER CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6301
Practice Address - Country:US
Practice Address - Phone:405-801-3147
Practice Address - Fax:888-975-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1992065908OtherNPI