Provider Demographics
NPI:1134578693
Name:NORRIS, ELISE KAYLIN KING (DDS)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:KAYLIN KING
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 1:2750 MILLERVILLE RD APT 3303
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0113
Mailing Address - Country:US
Mailing Address - Phone:225-333-0036
Mailing Address - Fax:
Practice Address - Street 1:554 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6552
Practice Address - Country:US
Practice Address - Phone:225-923-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA33444Medicaid