MEDICARE: DR. NORM REDDICK DMD

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	22542	CA

General Provider Information

NPI Number	:	1528136488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORM REDDICK DMD

Provider Business Mailing Address
First Line	:	32144 AGOURA RD
Second Line	:	#216
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4031
Country	:	US
Telephone Number	:	818-889-5367
Fax Number	:	818-889-4624

Provider Business Practice Location Address
First Line	:	32144 AGOURA RD
Second Line	:	#216
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4031
Country	:	US
Telephone Number	:	818-889-5367
Fax Number	:	818-889-4624

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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