MEDICARE: CHARLES G. NORMAN II DDS PC

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	2901017520	MI

General Provider Information

NPI Number	:	1255505137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES G. NORMAN II DDS PC

Provider Business Mailing Address
First Line	:	114 W NORTH ST
Second Line	:	SUITE 3, PO BOX 817
City	:	OWOSSO
State	:	MI
Zip	:	48867-1277
Country	:	US
Telephone Number	:	989-725-9855
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 W NORTH ST
Second Line	:	SUITE 3
City	:	OWOSSO
State	:	MI
Zip	:	48867-1277
Country	:	US
Telephone Number	:	989-725-9855
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES GODFREY NORMAN II
Credential	:	DDS
Telephone Number	:	989-725-9855

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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