Healthcare Provider Details

I. General information

NPI: 1730170549
Provider Name (Legal Business Name): KURT FRY SUMMERSGILL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE ST. SALK G-134
PITTSBURGH PA
15261-0001
US

IV. Provider business mailing address

3501 TERRACE ST. SALK G-134
PITTSBURGH PA
15261-0001
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-8635
  • Fax: 412-383-9142
Mailing address:
  • Phone: 412-648-8635
  • Fax: 412-383-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS026603L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: