Provider Demographics
NPI:1962026948
Name:SUMMERS, MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2001
Mailing Address - Country:US
Mailing Address - Phone:812-339-7743
Mailing Address - Fax:
Practice Address - Street 1:1320 W BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2001
Practice Address - Country:US
Practice Address - Phone:812-339-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013354A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist