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General NPI Number Information
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NPI Number | 1902941354
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Entity Type | Individual
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Provider Name | LOREN MYRON NORMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 91 E. 4TH AVE.
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City | AFTON
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State | WY
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Zip | 83110-1509
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Country | US
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Telephone | 307-885-5276
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Fax | 307-885-5276
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Provider Business Mailing Address
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Address Line | PO BOX 1509 91 E. 4TH AVE.
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City | AFTON
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State | WY
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Zip | 83110-1509
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Country | US
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Telephone | 307-885-5276
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Fax | 307-885-5276
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | WY1035
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License Number State | WY
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