=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962522839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINTON J. NORRIS, D.D.S., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2007
-----------------------------------------------------
Last Update Date | 12/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4445 COX RD
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23060-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-747-0044
-----------------------------------------------------
Fax | 804-968-4871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4445 COX RD
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23060-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-747-0044
-----------------------------------------------------
Fax | 804-968-4871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. CLINTON JOSEPH NORRIS III
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 804-747-0044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401007441
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------