Provider Demographics
NPI:1306120712
Name:SUMMIT DENTAL GROUP LLC
Entity type:Organization
Organization Name:SUMMIT DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIRONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-627-5666
Mailing Address - Street 1:1003 E. TURKEYFOOT LAKE RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312
Mailing Address - Country:US
Mailing Address - Phone:330-896-1959
Mailing Address - Fax:330-896-8944
Practice Address - Street 1:1003 E. TURKEYFOOT LAKE RD.
Practice Address - Street 2:SUITE A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312
Practice Address - Country:US
Practice Address - Phone:330-896-1959
Practice Address - Fax:330-896-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty