Provider Demographics
NPI:1639244387
Name:SUMMIT DENTAL LLC
Entity Type:Organization
Organization Name:SUMMIT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAMIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-547-8800
Mailing Address - Street 1:3225 W GORDON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8769
Mailing Address - Country:US
Mailing Address - Phone:801-547-8800
Mailing Address - Fax:
Practice Address - Street 1:3225 W GORDON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8769
Practice Address - Country:US
Practice Address - Phone:801-547-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361602-99231223G0001X
UT309191-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty