Provider Demographics
NPI:1639883622
Name:SUMMIT COMMUNITY DENTAL
Entity Type:Organization
Organization Name:SUMMIT COMMUNITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-202-1221
Mailing Address - Street 1:119 EAST ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9321
Mailing Address - Country:US
Mailing Address - Phone:567-400-2024
Mailing Address - Fax:
Practice Address - Street 1:119 EAST ST
Practice Address - Street 2:
Practice Address - City:LIBERTY CENTER
Practice Address - State:OH
Practice Address - Zip Code:43532-9321
Practice Address - Country:US
Practice Address - Phone:567-400-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty