Provider Demographics
NPI:1306096565
Name:NORRIS, JESSE BENJAMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BENJAMIN
Last Name:NORRIS
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:USA DENTAL CLINIC-HQ LANDSTHUL
Mailing Address - Street 2:CMR 402, BLDG 3703
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:314-590-2714
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL CLINIC-HQ LANDSTHUL
Practice Address - Street 2:CMR 402, BLDG 3703, RM 205
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:314-590-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice