Provider Demographics
NPI:1215311667
Name:SUMMERFORD, DAVID CLARK (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARK
Last Name:SUMMERFORD
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 BALMORAL DRIVE, SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-883-4032
Mailing Address - Fax:256-883-4029
Practice Address - Street 1:4032 BALMORAL DRIVE, SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-883-4032
Practice Address - Fax:256-883-4029
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6221C1122300000X
AL62211223G0001X, 1223P0300X
ALAL62211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice