Provider Demographics
NPI:1346789534
Name:SUMMIT DENTAL CARE PAUL, PLLC
Entity Type:Organization
Organization Name:SUMMIT DENTAL CARE PAUL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:FAADOM
Authorized Official - Phone:208-733-9999
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:PAUL
Mailing Address - State:ID
Mailing Address - Zip Code:83347-0549
Mailing Address - Country:US
Mailing Address - Phone:208-438-4855
Mailing Address - Fax:208-438-4835
Practice Address - Street 1:207 W ELLIS STREET
Practice Address - Street 2:
Practice Address - City:PAUL
Practice Address - State:ID
Practice Address - Zip Code:83347
Practice Address - Country:US
Practice Address - Phone:208-438-4855
Practice Address - Fax:208-438-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty