Provider Demographics
NPI:1528579695
Name:SUMMIT FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:SUMMIT FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-923-4510
Mailing Address - Street 1:9271 PEACH STREET
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441
Mailing Address - Country:US
Mailing Address - Phone:814-923-4510
Mailing Address - Fax:814-923-4199
Practice Address - Street 1:9271 PEACH STREET
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441
Practice Address - Country:US
Practice Address - Phone:814-923-4510
Practice Address - Fax:814-923-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental