Provider Demographics
NPI:1285240531
Name:SUMMIT DENTAL CENTER LLC
Entity type:Organization
Organization Name:SUMMIT DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUZAFFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-643-7860
Mailing Address - Street 1:7557 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1813
Mailing Address - Country:US
Mailing Address - Phone:708-924-1749
Mailing Address - Fax:630-359-4933
Practice Address - Street 1:7557 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1813
Practice Address - Country:US
Practice Address - Phone:708-924-1749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty