MEDICARE: DR. KURT FRY SUMMERSGILL D.D.S.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	DS026603L	PA

General Provider Information

NPI Number	:	1730170549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT FRY SUMMERSGILL D.D.S.

Provider Business Mailing Address
First Line	:	3501 TERRACE ST.
Second Line	:	SALK G-134
City	:	PITTSBURGH
State	:	PA
Zip	:	15261-0001
Country	:	US
Telephone Number	:	412-648-8635
Fax Number	:	412-383-9142

Provider Business Practice Location Address
First Line	:	3501 TERRACE ST.
Second Line	:	SALK G-134
City	:	PITTSBURGH
State	:	PA
Zip	:	15261-0001
Country	:	US
Telephone Number	:	412-648-8635
Fax Number	:	412-383-9142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	07/08/2007

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