Provider Demographics
NPI:1780857078
Name:NORMAN, JOSEPH ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALAN
Last Name:NORMAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N BRENTWOOD STE 400
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-7147
Mailing Address - Country:US
Mailing Address - Phone:936-639-4867
Mailing Address - Fax:
Practice Address - Street 1:103 N BRENTWOOD STE 400
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-7147
Practice Address - Country:US
Practice Address - Phone:936-639-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8542122300000X
TNDS00000101891223G0001X
TX262151223G0001X, 1223S0112X
OK3351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2188930-05Medicaid
TX2188930-03Medicaid
TX2188930-04Medicaid
NC5911732Medicaid
TX2188930-01Medicaid
TX2188930-02Medicaid