Provider Demographics
NPI:1427595297
Name:SILVER SUMMIT DENTAL
Entity Type:Organization
Organization Name:SILVER SUMMIT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-542-0998
Mailing Address - Street 1:5734 WEST 134000 SOUTH
Mailing Address - Street 2:#1
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6953
Mailing Address - Country:US
Mailing Address - Phone:801-542-0998
Mailing Address - Fax:385-695-5933
Practice Address - Street 1:5734 W 13400 S
Practice Address - Street 2:#1
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6953
Practice Address - Country:US
Practice Address - Phone:801-542-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty