Provider Demographics
NPI:1306041629
Name:SUMMERLIN, JAMIE D
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1038
Mailing Address - Country:US
Mailing Address - Phone:828-264-3333
Mailing Address - Fax:
Practice Address - Street 1:870 STATE FARM RD STE 103A
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4862
Practice Address - Country:US
Practice Address - Phone:828-264-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8603124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist