Provider Demographics
NPI:1356750137
Name:SUMMIT LAKES DENTAL CARE, L.L.C.
Entity type:Organization
Organization Name:SUMMIT LAKES DENTAL CARE, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-806-4001
Mailing Address - Street 1:3741 SW RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4606
Mailing Address - Country:US
Mailing Address - Phone:816-875-3339
Mailing Address - Fax:
Practice Address - Street 1:3741 SW RAINTREE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4606
Practice Address - Country:US
Practice Address - Phone:816-875-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty