Organization
MICHAEL G. SUMMERS DDS, MS, PA
Active
Organization
MICHAEL G. SUMMERS DDS, MS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL G. SUMMERS D.D.S., M.S. (OWNER)
(208) 232-0464
Entity
Organization
Contact information
Practice address
1133 CALL CREEK, SUITE B, POCATELLO, ID 83202
(208) 232-0464
(208) 232-0863
Mailing address
1133 CALL CREEK, SUITE B, POCATELLO, ID 83202
(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
05
—
000015300
—
ID
01
—
645574
UNITED CONCORDIA INS. CO.
ID
01
—
6G405
INSURANCE CO.
ID
01
—
6G421
INSURANCE CO.
ID
05
—
805033500
—
ID
05
—
9201874
—
ID
05
—
9202522
—
ID
01
—
963311
INSURANCE CO.
ID
Enumeration date
05/13/2008
Last updated
05/13/2008
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