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NPI Code Detail

MEDICARE: DR. ETHAN BRENT NORTON DMD

MEDICARE: DR. ETHAN BRENT NORTON DMD
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
1122300000XDentist11482NC

General Provider Information

NPI Number : 1760043764
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ETHAN BRENT NORTON DMD
Provider Business Mailing Address
First Line : 7745 TIMBERLINE OVERLOOK
Second Line :
City : CUMMING
State : GA
Zip : 30041-2157
Country : US
Telephone Number : 678-451-2122
Fax Number :
Provider Business Practice Location Address
First Line : 2011 N MAIN ST
Second Line :
City : HIGH POINT
State : NC
Zip : 27262-2133
Country : US
Telephone Number : 336-860-3210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2019
Last Update Date : 06/21/2019

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