Provider Demographics
NPI:1235760893
Name:SUMMIT DENTAL LAB, INC
Entity Type:Organization
Organization Name:SUMMIT DENTAL LAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-694-8234
Mailing Address - Street 1:13015 OLD GLENN HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7562
Mailing Address - Country:US
Mailing Address - Phone:907-696-5227
Mailing Address - Fax:
Practice Address - Street 1:13015 OLD GLENN HWY STE 150
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7562
Practice Address - Country:US
Practice Address - Phone:907-696-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory