Healthcare Provider Details

I. General information

NPI: 1972979128
Provider Name (Legal Business Name): SUMMERVILLE AND NORMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUEENS RD SUITE 310
CHARLOTTE NC
28204-3253
US

IV. Provider business mailing address

200 QUEENS RD SUITE 310
CHARLOTTE NC
28204-3253
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-5306
  • Fax:
Mailing address:
  • Phone: 704-334-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SUMMERVILLE
Title or Position: OWNER
Credential: D.D.S.
Phone: 704-965-7988