Individual
DR. MICHAEL G. SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
1133 CALL CREEK DR., POCATELLO, ID 83201-3000
(208) 232-0464
(208) 232-0863
Mailing address
1133 CALL CREEK DR., POCATELLO, ID 83201-3000
(208) 232-0464
(208) 232-0863
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-3284-OR
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6G405
BLUE CROSS OF ID
ID
01
—
6G421
BLUE CROSS OF IDAHO
ID
01
—
963311
UCCI
ID
Enumeration date
04/11/2007
Last updated
07/08/2007
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