Provider Demographics
NPI:1902941354
Name:NORMAN, LOREN MYRON (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:MYRON
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:PO BOX 1509
Mailing Address - Street 2:91 E. 4TH AVE.
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-1509
Mailing Address - Country:US
Mailing Address - Phone:307-885-5276
Mailing Address - Fax:307-885-5276
Practice Address - Street 1:91 E. 4TH AVE.
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-1509
Practice Address - Country:US
Practice Address - Phone:307-885-5276
Practice Address - Fax:307-885-5276
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY10351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice