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General NPI Number Information
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NPI Number | 1366933392
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Entity Type | Organization
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Legal Business Name | SUMMIT DENTAL, LLC
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 1658 OLD MONROVIA RD SUITE 102
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City | HUNTVILLE
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State | AL
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Zip | 35806
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Country | US
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Telephone | 256-251-2899
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Fax |
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Provider Business Mailing Address
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Address Line | 13357 TRUMPET DR
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City | MADISON
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State | AL
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Zip | 35756-3668
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Country | US
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Telephone | 256-426-1178
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. COURTNEY WILLIAMS MURRAY
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Credential | DDS
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Telephone | 256-426-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D.6457.C
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License Number State | AL
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