=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417361205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORMAN DENTISTRY & BRACES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2014
-----------------------------------------------------
Last Update Date | 06/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 S UNIVERSITY BLVD
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-6564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 SOUTH UNIVERSITY BOULDEVARD
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | TIM MCNAMARA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 405-321-6564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6595
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------