Provider Demographics
NPI:1164431177
Name:NORRIS, KIPTON JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIPTON
Middle Name:JAY
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 W. 2175 S.
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-773-3060
Mailing Address - Fax:
Practice Address - Street 1:1747 S. HERITAGE LN
Practice Address - Street 2:SUITE B-201
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075
Practice Address - Country:US
Practice Address - Phone:801-776-2461
Practice Address - Fax:801-776-2469
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53243841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice