Provider Demographics
NPI:1831589910
Name:DESERT SUMMIT DENTISTRY, PC
Entity type:Organization
Organization Name:DESERT SUMMIT DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-376-7233
Mailing Address - Street 1:21681 N 77TH AVE STE 1420
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2133
Mailing Address - Country:US
Mailing Address - Phone:623-376-7233
Mailing Address - Fax:623-376-7234
Practice Address - Street 1:21681 N 77TH AVE STE 1420
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2133
Practice Address - Country:US
Practice Address - Phone:623-376-7233
Practice Address - Fax:623-376-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDOO8946122300000X
AZHO2603124Q00000X
AZDO3749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty