Provider Demographics
NPI:1073971149
Name:SUMMIT DENTAL EXCELLENCE
Entity Type:Organization
Organization Name:SUMMIT DENTAL EXCELLENCE
Other - Org Name:MATTHEW L LEHMAN, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-567-0470
Mailing Address - Street 1:850 SUMMIT AVE STOP 1
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3920
Mailing Address - Country:US
Mailing Address - Phone:262-567-0470
Mailing Address - Fax:
Practice Address - Street 1:850 SUMMIT AVE STOP 1
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3920
Practice Address - Country:US
Practice Address - Phone:262-567-0470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty