Healthcare Provider Details

I. General information

NPI: 1538339460
Provider Name (Legal Business Name): NORMAN DELOACH JR. D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SEVERANCE CIR STE 805
CLEVELAND HEIGHTS OH
44118-1592
US

IV. Provider business mailing address

5 SEVERANCE CIR STE 805
CLEVELAND HEIGHTS OH
44118-1592
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-0301
  • Fax: 216-291-2516
Mailing address:
  • Phone: 216-291-0301
  • Fax: 216-291-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: