Provider Demographics
NPI:1639761851
Name:NORRIS, STEPHANIE (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S WHITE OAK DR APT 324
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-8347
Mailing Address - Country:US
Mailing Address - Phone:805-407-0017
Mailing Address - Fax:
Practice Address - Street 1:1350 S WHITE OAK DR APT 324
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-8347
Practice Address - Country:US
Practice Address - Phone:805-407-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1059101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice