Individual
WILLIAM SUMMERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
475 N WENDOVER RD, CHARLOTTE, NC 28211-1064
(704) 540-5400
(704) 364-5293
Mailing address
475 N WENDOVER RD, CHARLOTTE, NC 28211-1064
(704) 540-5400
(704) 364-5293
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7658
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900137
—
NC
01
—
9027K
BCBS PROVIDER NUMBER
NC
Enumeration date
08/17/2006
Last updated
03/27/2020
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