Healthcare Provider Details

I. General information

NPI: 1932061793
Provider Name (Legal Business Name): SUMMIT DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 COUNTY RD STE 4
SCARBOROUGH ME
04074-8203
US

IV. Provider business mailing address

87 OWLS NEST RD
PORTLAND ME
04102-1638
US

V. Phone/Fax

Practice location:
  • Phone: 207-503-0026
  • Fax:
Mailing address:
  • Phone: 207-503-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SONYA SHAFIQUE
Title or Position: OWNER
Credential: DMD
Phone: 207-503-0026