Organization
SUMMERLIN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK DONALD SUMMERLIN III DDS (OWNER)
(317) 926-5200
Entity
Organization
Contact information
Practice address
3351 N MERIDIAN ST STE 105, INDIANAPOLIS, IN 46208-4674
(317) 926-5200
(317) 947-1663
Mailing address
3351 N MERIDIAN ST STE 105, INDIANAPOLIS, IN 46208-4674
(317) 926-5200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/14/2019
Last updated
08/14/2019
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