Individual
DR. KEITH ALAN NORWALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
103 W 5TH ST, GENOA, OH 43430-1701
(419) 855-4700
Mailing address
103 W 5TH ST, GENOA, OH 43430-1701
(419) 855-4700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13729
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0151553
—
OH
01
—
9199924
DORAL
OH
Enumeration date
05/21/2007
Last updated
12/20/2012
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