MEDICARE: DR. JOHN TRENT NORRIS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	27048	CA

General Provider Information

NPI Number	:	1134232531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN TRENT NORRIS DDS

Provider Business Mailing Address
First Line	:	6529 CROWN BLVD STE A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2905
Country	:	US
Telephone Number	:	408-268-1891
Fax Number	:	408-268-5365

Provider Business Practice Location Address
First Line	:	6529 CROWN BLVD STE A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2905
Country	:	US
Telephone Number	:	408-268-1891
Fax Number	:	408-268-5365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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