Provider Demographics
NPI:1629485164
Name:NORRIS, RHODA-LEANN BALLENTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RHODA-LEANN
Middle Name:BALLENTINE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 CRESTBROOK LN SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1576
Mailing Address - Country:US
Mailing Address - Phone:404-406-9918
Mailing Address - Fax:
Practice Address - Street 1:6351 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7102
Practice Address - Country:US
Practice Address - Phone:770-577-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0148051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice