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General NPI Number Information
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NPI Number | 1356435705
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Entity Type | Organization
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Legal Business Name | SUMMIT FAMILY DENTAL, P.L.L.C.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 8136 21 MILE RD.
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City | SHELBY TWP.
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State | MI
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Zip | 48317
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Country | US
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Telephone | 586-726-0606
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Fax | 586-726-1523
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Provider Business Mailing Address
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Address Line | 8136 21 MILE RD.
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City | SHELBY TWP.
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State | MI
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Zip | 48317
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Country | US
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Telephone | 586-726-0606
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Fax | 586-726-1523
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KRISTA LYNN WORTMAN
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Credential | D.D.S.
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Telephone | 586-726-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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