Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS0000009930 | TN |
NPI | 1114304524 |
---|---|
Provider Name | Dr. Nicholas G Norvell |
First Address | Mount Juliet, TN 37122-6494 |
Second Address | Mount Juliet, TN 37122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 14/08/2019 |