Provider Demographics
NPI:1245434653
Name:DR W THOMAS NORMAN DDS P C
Entity type:Organization
Organization Name:DR W THOMAS NORMAN DDS P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-229-7267
Mailing Address - Street 1:1212 SW LUTTRELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-4912
Mailing Address - Country:US
Mailing Address - Phone:816-229-7267
Mailing Address - Fax:816-224-8402
Practice Address - Street 1:1212 SW LUTTRELL RD STE D
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4912
Practice Address - Country:US
Practice Address - Phone:816-229-7267
Practice Address - Fax:816-224-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO06948015OtherBLUE CROSS BLUE SHIELD
KS064954OtherBLUE CROSS BLUE SHIELD
197232OtherUNITED CONCORDIA