Provider Demographics
NPI:1932061793
Name:SUMMIT DENTAL, PLLC
Entity type:Organization
Organization Name:SUMMIT DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-503-0026
Mailing Address - Street 1:87 OWLS NEST RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1638
Mailing Address - Country:US
Mailing Address - Phone:207-503-0026
Mailing Address - Fax:
Practice Address - Street 1:91 COUNTY RD STE 4
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8203
Practice Address - Country:US
Practice Address - Phone:207-503-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty