Healthcare Provider Details

I. General information

NPI: 1700051455
Provider Name (Legal Business Name): SUMMIT FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LAUREL STREET
SUMMIT MS
39666
US

IV. Provider business mailing address

PO BOX 789
SUMMIT MS
39666-0789
US

V. Phone/Fax

Practice location:
  • Phone: 601-276-7915
  • Fax: 601-276-7929
Mailing address:
  • Phone: 601-276-7915
  • Fax: 601-276-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1766-77
License Number StateMS

VIII. Authorized Official

Name: DR. DONALD E. PRICE
Title or Position: OWNER
Credential: D.D.S.
Phone: 601-276-7915