Provider Demographics
NPI:1114131208
Name:NORRIS, LONNIE H (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:H
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNEELAND ST
Mailing Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1527
Mailing Address - Country:US
Mailing Address - Phone:617-636-6636
Mailing Address - Fax:617-636-0309
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6636
Practice Address - Fax:617-636-0309
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA013391OtherTUFTS HEALTH
MA0013332OtherNEIGHBORHOOD HEALTH
MA4336614OtherATENA
MA16186NEMCOtherHARVARD
MA4651255OtherCIGNA
MA0264679Medicaid
MA100969OtherDELTA DENTAL
MAX04341Medicare ID - Type Unspecified