# ADVANCED DENTAL CARE OF FORTVILLE, 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:** 1205454014
- **Authorized official:** JACK SUMMERLIN III DDS (OWNER)
- **Authorized official phone:** (765) 485-7000

## Contact information

- **Practice address:** 545 VITALITY DR STE F, FORTVILLE, IN 46040-1373
- **Practice address phone:** (317) 485-7000
- **Mailing address:** 545 VITALITY DR STE F, FORTVILLE, IN 46040-1373
- **Mailing address phone:** (317) 485-7000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 07/08/2020
- **Last updated:** 07/08/2020