Organization
JED R. NORMAN DDS LLC
Active
Other names
Glide Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JED R NORMAN DDS (OWNER/DENTIST)
(541) 672-6511
Entity
Organization
Contact information
Practice address
1813 W HARVARD AVE STE 221, ROSEBURG, OR 97471-8704
(541) 672-6511
(541) 673-1892
Mailing address
1813 W HARVARD AVE STE 221, ROSEBURG, OR 97471-8704
(541) 672-6511
(541) 673-1892
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8859
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278647
—
OR
Enumeration date
06/05/2013
Last updated
06/05/2013
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