Healthcare Provider Details

I. General information

NPI: 1962052035
Provider Name (Legal Business Name): SUMMIT AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34209 N. SCOTTSDALE RD SUITE 103
SCOTTSDALE AZ
85266
US

IV. Provider business mailing address

34209 N. SCOTTSDALE RD SUITE 103
SCOTTSDALE AZ
85266
US

V. Phone/Fax

Practice location:
  • Phone: 480-787-0701
  • Fax: 480-393-7439
Mailing address:
  • Phone: 480-787-0701
  • Fax: 480-393-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WILLIAM KUERSCHNER
Title or Position: OWNER/ORAL SURGEON
Credential: DDS
Phone: 480-787-0701