Provider Demographics
NPI:1891812731
Name:NORRIS, LEMONT TERRANCE (DDS)
Entity type:Individual
Prefix:DR
First Name:LEMONT
Middle Name:TERRANCE
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 1:1713 CLAY ST
Mailing Address - Street 2:STE 5
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-3048
Mailing Address - Country:US
Mailing Address - Phone:601-638-7007
Mailing Address - Fax:601-638-0760
Practice Address - Street 1:1713 CLAY ST
Practice Address - Street 2:STE 5
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-3048
Practice Address - Country:US
Practice Address - Phone:601-638-7007
Practice Address - Fax:601-638-0760
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2864-951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS818510OtherUNITED CONCORDIA
MS00660173Medicaid