Provider Demographics
NPI:1801922968
Name:NORRIS, RUSSELL SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:SCOTT
Last Name:NORRIS
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 1:105 LAWRENCE DR
Mailing Address - Street 2:P.O. BOX 682
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-1242
Mailing Address - Country:US
Mailing Address - Phone:812-838-6523
Mailing Address - Fax:812-838-6584
Practice Address - Street 1:105 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-1242
Practice Address - Country:US
Practice Address - Phone:812-838-6523
Practice Address - Fax:812-838-6584
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120073721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice