Healthcare Provider Details

I. General information

NPI: 1588734438
Provider Name (Legal Business Name): ANDREW GREGG NORKIN D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 GLADES RD SUITE #309
BOCA RATON FL
33431-7209
US

IV. Provider business mailing address

2499 GLADES RD SUITE #309
BOCA RATON FL
33431-7209
US

V. Phone/Fax

Practice location:
  • Phone: 561-826-2002
  • Fax: 561-826-2003
Mailing address:
  • Phone: 561-826-2002
  • Fax: 561-826-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN 17306
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME 95024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: