MEDICARE: DR W THOMAS NORMAN DDS P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06948015	OTHER	MO	BLUE CROSS BLUE SHIELD
2	064954	OTHER	KS	BLUE CROSS BLUE SHIELD
3	197232	OTHER		UNITED CONCORDIA

General Provider Information

NPI Number	:	1245434653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR W THOMAS NORMAN DDS P C

Provider Business Mailing Address
First Line	:	1212 SW LUTTRELL RD STE D
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-4912
Country	:	US
Telephone Number	:	816-229-7267
Fax Number	:	816-224-8402

Provider Business Practice Location Address
First Line	:	1212 SW LUTTRELL RD STE D
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-4912
Country	:	US
Telephone Number	:	816-229-7267
Fax Number	:	816-224-8402

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM THOMAS NORMAN
Credential	:	DDS
Telephone Number	:	816-229-7267

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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