Provider Demographics
NPI:1104005123
Name:SUMMERS, EDDIE LEE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:LEE
Last Name:SUMMERS
Suffix:JR
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 1:314 S GOLDEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-9275
Mailing Address - Country:US
Mailing Address - Phone:409-935-5663
Mailing Address - Fax:
Practice Address - Street 1:9850 EMMETT F LOWRY EXPY STE C
Practice Address - Street 2:SUITE C-103
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2001
Practice Address - Country:US
Practice Address - Phone:409-949-3406
Practice Address - Fax:409-949-3492
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice