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General NPI Number Information
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NPI Number | 1407172331
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Entity Type | Organization
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Legal Business Name | SUMMIT DENTAL, INC
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 1421 CENTRAL AVENUE
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City | HOT SPRINGS
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State | AR
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Zip | 71901
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Country | US
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Telephone | 801-623-8333
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Fax | 501-623-8331
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Provider Business Mailing Address
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Address Line | 1421 CENTRAL AVENUE
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City | HOT SPRINGS
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State | AR
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Zip | 71901
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Country | US
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Telephone | 501-623-8333
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Fax | 501-623-8331
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PAMELA RENEE HALBROOK
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Credential |
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Telephone | 501-623-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2967
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | AR
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