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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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