Provider Demographics
NPI:1124273768
Name:SUMMIT DENTAL, P.C.
Entity type:Organization
Organization Name:SUMMIT DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-595-1400
Mailing Address - Street 1:6254 97TH PL
Mailing Address - Street 2:SUITE C2
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:718-595-1400
Mailing Address - Fax:718-595-1258
Practice Address - Street 1:6254 97TH PL
Practice Address - Street 2:SUITE C2
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1346
Practice Address - Country:US
Practice Address - Phone:718-595-1400
Practice Address - Fax:718-595-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY428971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty