Provider Demographics
NPI:1235283599
Name:NORRIS, SAMUEL THOMAS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THOMAS
Last Name:NORRIS
Suffix:JR
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 1:2925 PLAYER ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4950
Mailing Address - Country:US
Mailing Address - Phone:912-264-9250
Mailing Address - Fax:912-265-7191
Practice Address - Street 1:2925 PLAYER ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4950
Practice Address - Country:US
Practice Address - Phone:912-264-9250
Practice Address - Fax:912-265-7191
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0126401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics