Provider Demographics
NPI:1841454626
Name:SUMMERS, LAURA MILLS (DMD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MILLS
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ASHLEY
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:280 NORTH GROVE MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4222
Mailing Address - Country:US
Mailing Address - Phone:864-585-3318
Mailing Address - Fax:864-585-4800
Practice Address - Street 1:280 NORTH GROVE MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4222
Practice Address - Country:US
Practice Address - Phone:864-585-3318
Practice Address - Fax:864-585-4800
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1388Medicare PIN