Provider Demographics
NPI:1972089118
Name:SUMMIT INTEGRATIVE DENTAL (BROMLEY, D.D.S. AND BROYLES, D.D.S.), P.C.
Entity Type:Organization
Organization Name:SUMMIT INTEGRATIVE DENTAL (BROMLEY, D.D.S. AND BROYLES, D.D.S.), P.C.
Other - Org Name:SUMMIT INTEGRATIVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-525-5257
Mailing Address - Street 1:688 SE BAYBERRY LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063
Mailing Address - Country:US
Mailing Address - Phone:816-525-5257
Mailing Address - Fax:
Practice Address - Street 1:688 SE BAYBERRY LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063
Practice Address - Country:US
Practice Address - Phone:816-525-5257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty