Provider Demographics
NPI:1083913198
Name:KETRON, SUMMER CELESTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:CELESTE
Last Name:KETRON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 78TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3103
Mailing Address - Country:US
Mailing Address - Phone:806-928-2080
Mailing Address - Fax:
Practice Address - Street 1:5301 50TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-5834
Practice Address - Country:US
Practice Address - Phone:806-793-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice