Individual provider Active NPI

Kevin L. Norris, D.M.D.

  • Dentist
  • South Ogden, UT
National Provider Identifier
1528088580
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
373441 Issued in UT
Practice address
1770 Combe Rd Ste 4
South Ogden, UT 84403-5067
Phone
(801) 475-4511
Fax
(801) 475-4088
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 373441 UT Primary

Addresses

Primary practice location

1770 Combe Rd Ste 4
South Ogden, UT 84403-5067

Mailing address

1770 Combe Rd Ste 4
South Ogden, UT 84403-5067
Phone (801) 475-4511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160302002400 UT Order and Referring Only - DentistPractitioner - Dentist 5496051328

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
373441UTMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528088580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 COMBE RD STE 4",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844035067",
            "telephone_number": "801-475-4511",
            "fax_number": "801-475-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 COMBE RD STE 4",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844035067",
            "telephone_number": "801-475-4511",
            "fax_number": "801-475-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORRIS",
        "first_name": "KEVIN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "373441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Ogden, UT

Sources for this page

Verify at the official NPI Registry.