Provider Demographics
NPI:1811336746
Name:SUMNER, BEALE MCKENZIE III (DDS)
Entity type:Individual
Prefix:DR
First Name:BEALE
Middle Name:MCKENZIE
Last Name:SUMNER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5332
Mailing Address - Country:US
Mailing Address - Phone:336-786-6612
Mailing Address - Fax:336-786-2128
Practice Address - Street 1:1124 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5332
Practice Address - Country:US
Practice Address - Phone:336-786-6612
Practice Address - Fax:336-786-2128
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist