Provider Demographics
NPI:1043109606
Name:MACK, SUMMER DENTAL (DMD)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DENTAL
Last Name:MACK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SUMMER
Other - Middle Name:SOPHIA
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:275 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5430
Mailing Address - Country:US
Mailing Address - Phone:614-318-3116
Mailing Address - Fax:
Practice Address - Street 1:12 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-295-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist