Provider Demographics
NPI:1265558332
Name:ELLOWAY, NORMAN IVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:IVAN
Last Name:ELLOWAY
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 1:1316 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3100
Mailing Address - Country:US
Mailing Address - Phone:415-897-8338
Mailing Address - Fax:415-897-4729
Practice Address - Street 1:1316 GRANT AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3100
Practice Address - Country:US
Practice Address - Phone:415-897-8338
Practice Address - Fax:415-897-4729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD219841223G0001X
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice