Individual
JOHN W SUMMERVILLE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
8 ESSEX WAY, SUITE 100, ESSEX JCT, VT 05452-3425
(802) 879-1233
(802) 879-3181
Mailing address
8 ESSEX WAY, SUITE 100, ESSEX JCT, VT 05452-3425
(802) 879-1233
(802) 879-3181
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002443
—
VT
01
—
SUMM2443
BCBS
VT
Enumeration date
06/05/2006
Last updated
07/08/2007
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