Healthcare Provider Details

I. General information

NPI: 1043109606
Provider Name (Legal Business Name): SUMMER SOPHIA MACK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMMER SOPHIA MACK DMD

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 TURNER ST # B
ABERDEEN NC
28315-2363
US

IV. Provider business mailing address

292 TURNER ST # B
ABERDEEN NC
28315-2363
US

V. Phone/Fax

Practice location:
  • Phone: 910-505-9062
  • Fax:
Mailing address:
  • Phone: 614-318-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: