# SUMMIT DENTAL SPECIALTY PLLC

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

## Provider details

- **NPI number:** 1871018887
- **Authorized official:** SHIELA DOMINGUEZ (MANAGING MEMBER)
- **Authorized official phone:** (480) 669-6419

## Contact information

- **Practice address:** 15810 S 45TH ST STE 120, PHOENIX, AZ 85048-7695
- **Practice address phone:** (480) 893-3636
- **Practice address fax:** (480) 893-3635
- **Mailing address:** 15810 S 45TH ST STE 120, PHOENIX, AZ 85048-7695
- **Mailing address phone:** (480) 893-3636
- **Mailing address fax:** (480) 893-3635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | D9064 | AZ | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | D06147 | AZ | — |

## Other

- **Enumeration date:** 08/10/2017
- **Last updated:** 07/21/2022