Provider Demographics
NPI:1205314762
Name:SUMMERBROOK DENTAL GROUP, LLC
Entity type:Organization
Organization Name:SUMMERBROOK DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TOLIVER
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-693-1215
Mailing Address - Street 1:14991 E HAMPDEN AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3996
Mailing Address - Country:US
Mailing Address - Phone:303-693-1215
Mailing Address - Fax:303-693-6452
Practice Address - Street 1:14991 E HAMPDEN AVE STE 370
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3996
Practice Address - Country:US
Practice Address - Phone:303-693-1215
Practice Address - Fax:303-693-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty