Provider Demographics
NPI:1508752353
Name:WATERS, SUMMER (RDH)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-8614
Mailing Address - Country:US
Mailing Address - Phone:816-813-8186
Mailing Address - Fax:
Practice Address - Street 1:706 NW HWY 7
Practice Address - Street 2:SUITE A
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-622-2843
Practice Address - Fax:816-598-8914
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020022650124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist