Provider Demographics
NPI:1255400172
Name:SUMMERS, BRIAN R (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 STERLING TRACE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9323
Mailing Address - Country:US
Mailing Address - Phone:252-756-3538
Mailing Address - Fax:252-317-8335
Practice Address - Street 1:108 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5936
Practice Address - Country:US
Practice Address - Phone:252-756-1456
Practice Address - Fax:252-317-8335
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC98211OtherBCBS PROVIDER NUMBER
NC98211OtherBCBS PROVIDER NUMBER