Provider Demographics
NPI:1346535887
Name:SUMRALL, JOSEPH G (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:SUMRALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3904
Mailing Address - Country:US
Mailing Address - Phone:478-929-1661
Mailing Address - Fax:478-929-1219
Practice Address - Street 1:100 S HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3904
Practice Address - Country:US
Practice Address - Phone:478-929-1661
Practice Address - Fax:478-929-1219
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1396838553OtherHOUSTON DENTAL PROFESSIONALS - PRACTICE NPI