Provider Demographics
NPI:1578654406
Name:NORMAN, NEIL ORLEW (DDS)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:ORLEW
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837
Mailing Address - Country:US
Mailing Address - Phone:208-786-7031
Mailing Address - Fax:208-783-7651
Practice Address - Street 1:302 E CAMERON AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837
Practice Address - Country:US
Practice Address - Phone:208-786-7031
Practice Address - Fax:208-783-7651
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist