Provider Demographics
NPI:1932235769
Name:NOROVICH, STEPHEN NICKOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NICKOLAS
Last Name:NOROVICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1031
Mailing Address - Country:US
Mailing Address - Phone:262-632-9921
Mailing Address - Fax:
Practice Address - Street 1:2601 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2865
Practice Address - Country:US
Practice Address - Phone:262-632-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001641-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice