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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