Provider Demographics
NPI:1396744629
Name:SUMMIT ORTHODONTICS
Entity type:Organization
Organization Name:SUMMIT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-646-9600
Mailing Address - Street 1:15258 SUMMIT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0233
Mailing Address - Country:US
Mailing Address - Phone:909-646-9600
Mailing Address - Fax:909-646-9878
Practice Address - Street 1:15258 SUMMIT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0233
Practice Address - Country:US
Practice Address - Phone:909-646-9600
Practice Address - Fax:909-646-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty