Provider Demographics
NPI:1073656567
Name:SUMMIT ORAL SURGERY & IMPLANT CENTER
Entity Type:Organization
Organization Name:SUMMIT ORAL SURGERY & IMPLANT CENTER
Other - Org Name:SUMMIT ORAL SURGERY AND IMPLANT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIFFETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-259-7438
Mailing Address - Street 1:625 HENRY CHAPPLE ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1839
Mailing Address - Country:US
Mailing Address - Phone:406-259-7438
Mailing Address - Fax:406-259-9729
Practice Address - Street 1:625 HENRY CHAPPLE ST.
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1839
Practice Address - Country:US
Practice Address - Phone:406-259-7438
Practice Address - Fax:406-259-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112397100Medicaid
MT000008990Medicare PIN