Provider Demographics
NPI:1023179009
Name:SUMMERLIN, ALLEN W (DDS)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:W
Last Name:SUMMERLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 E 39TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8209
Mailing Address - Country:US
Mailing Address - Phone:918-453-8335
Mailing Address - Fax:
Practice Address - Street 1:100 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-3018
Practice Address - Country:US
Practice Address - Phone:918-473-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist