Provider Demographics
NPI:1720242167
Name:TYSON, SUMMER BARKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:BARKER
Last Name:TYSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUMMER
Other - Middle Name:LEIGH
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:620 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5859
Mailing Address - Country:US
Mailing Address - Phone:870-336-9700
Mailing Address - Fax:
Practice Address - Street 1:620 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5859
Practice Address - Country:US
Practice Address - Phone:870-336-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168646608Medicaid