Provider Demographics
NPI:1821201708
Name:SUMMERS ORTHODONTICS, PA
Entity Type:Organization
Organization Name:SUMMERS ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-244-7545
Mailing Address - Street 1:4501 OLD SPARTANBURG RD STE 2
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4105
Mailing Address - Country:US
Mailing Address - Phone:864-244-7545
Mailing Address - Fax:864-244-7767
Practice Address - Street 1:4501 OLD SPARTANBURG RD STE 2
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4105
Practice Address - Country:US
Practice Address - Phone:864-244-7545
Practice Address - Fax:864-244-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty