Provider Demographics
NPI:1578766978
Name:KASSMEL, SUMMER MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:MARIE
Last Name:KASSMEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:56 MARKET STREET SUITE 5
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631
Mailing Address - Country:US
Mailing Address - Phone:970-328-1116
Mailing Address - Fax:970-328-0524
Practice Address - Street 1:56 MARKET STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-328-1116
Practice Address - Fax:970-328-0524
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist