Provider Demographics
NPI:1396962981
Name:SUMSION, JEFFREY REX (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:REX
Last Name:SUMSION
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 SILVER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5913
Mailing Address - Country:US
Mailing Address - Phone:435-649-0099
Mailing Address - Fax:
Practice Address - Street 1:4585 SILVER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5913
Practice Address - Country:US
Practice Address - Phone:435-649-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145258-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics