Healthcare Provider Details

I. General information

NPI: 1902941354
Provider Name (Legal Business Name): LOREN MYRON NORMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 E. 4TH AVE.
AFTON WY
83110-1509
US

IV. Provider business mailing address

PO BOX 1509 91 E. 4TH AVE.
AFTON WY
83110-1509
US

V. Phone/Fax

Practice location:
  • Phone: 307-885-5276
  • Fax: 307-885-5276
Mailing address:
  • Phone: 307-885-5276
  • Fax: 307-885-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWY1035
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: