Provider Demographics
NPI:1760048961
Name:NORRIS, RODNEY RAY (DDS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:RAY
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 LA COSTE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-7027
Mailing Address - Country:US
Mailing Address - Phone:330-720-2995
Mailing Address - Fax:
Practice Address - Street 1:423 ADAIR AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2962
Practice Address - Country:US
Practice Address - Phone:740-201-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist