Organization
SUMMIT DENTAL SPECIALTY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIELA DOMINGUEZ (MANAGING MEMBER)
(480) 669-6419
Entity
Organization
Contact information
Practice address
15810 S 45TH ST STE 120, PHOENIX, AZ 85048-7695
(480) 893-3636
(480) 893-3635
Mailing address
15810 S 45TH ST STE 120, PHOENIX, AZ 85048-7695
(480) 893-3636
(480) 893-3635
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D9064
AZ
1223P0106X
Oral and Maxillofacial Pathology Dentistry
D06147
AZ
Other
Enumeration date
08/10/2017
Last updated
07/21/2022
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