Individual
DR. JACK DONALD SUMMERLIN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3351 N MERIDIAN ST, SUITE 105, INDIANAPOLIS, IN 46208-4479
(317) 926-5200
Mailing address
3351 N MERIDIAN ST, SUITE 105, INDIANAPOLIS, IN 46208-4479
(317) 926-5200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7904
IN
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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