Provider Demographics
NPI:1700900792
Name:NORIGE, KEVIN HUGO (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HUGO
Last Name:NORIGE
Suffix:
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:PO BOX 791
Mailing Address - Street 2:112 DEMING ST.
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-0791
Mailing Address - Country:US
Mailing Address - Phone:860-644-0113
Mailing Address - Fax:860-644-5258
Practice Address - Street 1:112 DEMING ST
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3711
Practice Address - Country:US
Practice Address - Phone:860-644-0113
Practice Address - Fax:860-644-5258
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice