Provider Demographics
NPI:1447761853
Name:SUMNER, MARLENE MENDICINO (DDS)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MENDICINO
Last Name:SUMNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13302 MING HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5881
Mailing Address - Country:US
Mailing Address - Phone:210-643-4409
Mailing Address - Fax:
Practice Address - Street 1:834 NW LOOP 410 STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5604
Practice Address - Country:US
Practice Address - Phone:210-340-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice