Provider Demographics
NPI:1386799856
Name:SUMMER, ANGELICA P (DPD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:P
Last Name:SUMMER
Suffix:
Gender:F
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6322
Mailing Address - Country:US
Mailing Address - Phone:206-445-0030
Mailing Address - Fax:844-471-7739
Practice Address - Street 1:11540 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6322
Practice Address - Country:US
Practice Address - Phone:206-445-0030
Practice Address - Fax:844-471-7739
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000121122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist