MEDICARE: MICHAEL A NORMAN D.M.D.

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	008755	CT

General Provider Information

NPI Number	:	1699795575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A NORMAN D.M.D.

Provider Business Mailing Address
First Line	:	53 CRANBERRY LN
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-5163
Country	:	US
Telephone Number	:	860-729-4492
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 ELM ST
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-4635
Country	:	US
Telephone Number	:	203-933-2223
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/29/2013

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