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Organization
ADVANCED DENTAL CARE OF FORTVILLE, LLC
Active
Organization
ADVANCED DENTAL CARE OF FORTVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK SUMMERLIN III DDS (OWNER)
(765) 485-7000
Entity
Organization
Contact information
Practice address
545 VITALITY DR STE F, FORTVILLE, IN 46040-1373
(317) 485-7000
Mailing address
545 VITALITY DR STE F, FORTVILLE, IN 46040-1373
(317) 485-7000
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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