Individual
DR. JACK DONALD SUMMERLIN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3351 N MERIDIAN ST, SUITE 105, INDIANAPOLIS, IN 46208-4675
(317) 926-5200
Mailing address
3351 N MERIDIAN ST, SUITE 105, INDIANAPOLIS, IN 46208-4675
(317) 926-5200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011175A
IN
Other
Enumeration date
08/19/2008
Last updated
12/28/2020
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