MEDICARE: DR. CARL PATTERSON NORMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30014544	OH

General Provider Information

NPI Number	:	1124102215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL PATTERSON NORMAN DDS

Provider Business Mailing Address
First Line	:	PO BOX 200429
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-9429
Country	:	US
Telephone Number	:	216-921-4900
Fax Number	:	216-921-3809

Provider Business Practice Location Address
First Line	:	11900 SHAKER BLVD
Second Line	:	2ND FLOOR
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1925
Country	:	US
Telephone Number	:	216-921-4900
Fax Number	:	216-921-3809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/02/2012

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