Provider Demographics
NPI:1508289364
Name:SUMMER CREEK DENTAL
Entity Type:Organization
Organization Name:SUMMER CREEK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-870-3876
Mailing Address - Street 1:11501 N SAM HOUSTON PKWY E
Mailing Address - Street 2:STE C
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4635
Mailing Address - Country:US
Mailing Address - Phone:281-454-2000
Mailing Address - Fax:281-454-2002
Practice Address - Street 1:11501 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE C
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4635
Practice Address - Country:US
Practice Address - Phone:281-454-2000
Practice Address - Fax:281-454-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty