Healthcare Provider Details

I. General information

NPI: 1982516803
Provider Name (Legal Business Name): SUMMIT DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 23RD AVE
MERIDIAN MS
39301-3102
US

IV. Provider business mailing address

1603 23RD AVE
MERIDIAN MS
39301-3102
US

V. Phone/Fax

Practice location:
  • Phone: 601-568-4244
  • Fax: 601-568-4245
Mailing address:
  • Phone: 601-568-4244
  • Fax: 601-568-4245

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: WILLIAM BROCK MARTIN
Title or Position: DMD/OWNER
Credential: DMD
Phone: 601-568-4244