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General NPI Number Information
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NPI Number | 1992437206
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Entity Type | Individual
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Provider Name | SUMMER TRENT RDH
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 968 1ST INFANTRY DIVISION RD
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City | FORT KNOX
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State | KY
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Zip | 40121-5210
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Country | US
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Telephone | 502-626-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 ORIOLE DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5405
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Country | US
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Telephone | 717-440-1254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH06979
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License Number State | PA
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