Healthcare Provider Details

I. General information

NPI: 1144339722
Provider Name (Legal Business Name): GLENN H NORTON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 WASHINGTON AVE
EVANSVILLE IN
47714-2349
US

IV. Provider business mailing address

2343 WASHINGTON AVE
EVANSVILLE IN
47714-2349
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-0229
  • Fax: 812-476-4677
Mailing address:
  • Phone: 812-479-0229
  • Fax: 812-476-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6675
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: