MEDICARE: TERRY R SUMMERS 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
1	1223P0221X	Pediatric Dentistry	16876	TX

General Provider Information

NPI Number	:	1659550689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY R SUMMERS DDS

Provider Business Mailing Address
First Line	:	5920 SARATOGA BLVD
Second Line	:	SUITE 370
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4119
Country	:	US
Telephone Number	:	361-851-1876
Fax Number	:	361-890-0980

Provider Business Practice Location Address
First Line	:	5920 SARATOGA BLVD
Second Line	:	SUITE 370
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4119
Country	:	US
Telephone Number	:	361-851-1876
Fax Number	:	361-890-0980

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERRY R SUMMERS
Credential	:	DDS
Telephone Number	:	361-851-1876

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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