# SUMMIT DENTAL HEALTH - BLONDO LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124418892
- **Authorized official:** COREZ LOGAN (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (502) 254-8500

## Contact information

- **Practice address:** 2005 N 90TH ST, OMAHA, NE 68134-6002
- **Practice address phone:** (402) 799-1016
- **Practice address fax:** (402) 513-2745
- **Mailing address:** PO BOX 437169, LOUISVILLE, KY 40253-7169
- **Mailing address phone:** (502) 254-8500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/02/2015
- **Last updated:** 02/02/2015