Provider Demographics
NPI:1508368093
Name:SUMMIT DENTAL CARE ONE
Entity Type:Organization
Organization Name:SUMMIT DENTAL CARE ONE
Other - Org Name:SUMMIT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-322-4949
Mailing Address - Street 1:610 5TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1827
Mailing Address - Country:US
Mailing Address - Phone:719-322-4949
Mailing Address - Fax:
Practice Address - Street 1:5725 ERINDALE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1984
Practice Address - Country:US
Practice Address - Phone:719-322-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty