MEDICARE: DR. CHARLES GODFREY NORMAN II D.D.S.

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	:	1407905110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES GODFREY NORMAN II D.D.S.

Provider Business Mailing Address
First Line	:	6800 NEWARK RD
Second Line	:	SUITE 200
City	:	IMLAY CITY
State	:	MI
Zip	:	48444-9656
Country	:	US
Telephone Number	:	810-721-7453
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 NEWARK RD
Second Line	:	SUITE 200
City	:	IMLAY CITY
State	:	MI
Zip	:	48444-9656
Country	:	US
Telephone Number	:	810-721-7453
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	04/09/2021

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