Provider Demographics
NPI:1932244118
Name:PROULX, NORMAN HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:HENRY
Last Name:PROULX
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 1:1140 SOMERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2847
Mailing Address - Country:US
Mailing Address - Phone:603-624-4313
Mailing Address - Fax:603-624-1695
Practice Address - Street 1:1140 SOMERVILLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2847
Practice Address - Country:US
Practice Address - Phone:603-624-4313
Practice Address - Fax:603-624-1695
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice