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NPI Code Detail

MEDICARE: DR. SUMMER CHEYENNE BOOTH DDS

MEDICARE: DR. SUMMER CHEYENNE BOOTH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1609716869
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUMMER CHEYENNE BOOTH DDS
Provider Business Mailing Address
First Line : 2744 W FLORIMOND RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85086-6655
Country : US
Telephone Number : 623-810-3458
Fax Number :
Provider Business Practice Location Address
First Line : 5835 E STILL CIR
Second Line :
City : MESA
State : AZ
Zip : 85206-3618
Country : US
Telephone Number : 480-248-8107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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