Provider Demographics
NPI:1407172331
Name:SUMMIT DENTAL, INC
Entity Type:Organization
Organization Name:SUMMIT DENTAL, INC
Other - Org Name:DENTAL CARE ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HALBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-623-8333
Mailing Address - Street 1:1421 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-623-8333
Mailing Address - Fax:501-623-8331
Practice Address - Street 1:1421 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:801-623-8333
Practice Address - Fax:501-623-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2967122300000X
AR122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112366608Medicaid