MEDICARE: DR. GINA MARIE NORMAN-BOATRIGHT 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	12010755A	IN

General Provider Information

NPI Number	:	1164543260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA MARIE NORMAN-BOATRIGHT DDS

Provider Business Mailing Address
First Line	:	PO BOX 94
Second Line	:
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-0094
Country	:	US
Telephone Number	:	765-653-3393
Fax Number	:	765-653-6397

Provider Business Practice Location Address
First Line	:	125 E WASHINGTON ST
Second Line	:
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-1511
Country	:	US
Telephone Number	:	765-653-3393
Fax Number	:	765-653-6397

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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