| Summit Dental Specialty Pllc | |
|
15810 S 45th St Ste 120 Phoenix AZ 85048-7695 | |
| (480) 893-3636 | |
| (480) 893-3635 |
| Full Name | Summit Dental Specialty Pllc |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 15810 S 45th St Ste 120, Phoenix, Arizona |
| Authorized Official Name and Position | Shiela Dominguez (MANAGING MEMBER) |
| Authorized Official Contact | 4806696419 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Dental Specialty Pllc 15810 S 45th St Ste 120 Phoenix AZ 85048-7695 Ph: (480) 893-3636 | Summit Dental Specialty Pllc 15810 S 45th St Ste 120 Phoenix AZ 85048-7695 Ph: (480) 893-3636 |
| NPI Number | 1871018887 |
|---|---|
| Provider Enumeration Date | 08/10/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871018887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | D06147 (Arizona) | Secondary |
| 1223E0200X | Dentist - Endodontics | D9064 (Arizona) | Primary |
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