Provider Demographics
NPI:1013662774
Name:SUMMIT SMILES PLLC
Entity Type:Organization
Organization Name:SUMMIT SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYDIATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-638-6361
Mailing Address - Street 1:7300 E ARAPAHOE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6147
Mailing Address - Country:US
Mailing Address - Phone:720-638-6361
Mailing Address - Fax:720-583-1354
Practice Address - Street 1:7300 E ARAPAHOE RD STE 500
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6147
Practice Address - Country:US
Practice Address - Phone:720-638-6361
Practice Address - Fax:720-583-1354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT SMILES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-21
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty