Provider Demographics
NPI:1760611693
Name:SUMNER, MICHAEL S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SUMNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8153 NEW LA GRANGE RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4680
Mailing Address - Country:US
Mailing Address - Phone:502-425-3451
Mailing Address - Fax:
Practice Address - Street 1:8153 NEW LA GRANGE RD
Practice Address - Street 2:STE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4680
Practice Address - Country:US
Practice Address - Phone:502-425-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist