=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205007598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIR FRANCIS DRAKE DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2008
-----------------------------------------------------
Last Update Date | 03/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 919 SIR FRANCIS DRAKE BLVD
-----------------------------------------------------
City | KENTFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-453-2273
-----------------------------------------------------
Fax | 415-453-3254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 919 SIR FRANCIS DRAKE BLVD
-----------------------------------------------------
City | KENTFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-453-2273
-----------------------------------------------------
Fax | 415-453-3254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST PARTNER
-----------------------------------------------------
Name | DR. INTA K SVANS SUMMERS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 415-453-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 20276
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 46694
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------