Provider Demographics
NPI:1932169133
Name:SUMMER, JOHN D (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:SUMMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE.
Mailing Address - Street 2:#810
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205
Mailing Address - Country:US
Mailing Address - Phone:503-241-7353
Mailing Address - Fax:503-525-2966
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:#810
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2125
Practice Address - Country:US
Practice Address - Phone:503-241-7353
Practice Address - Fax:503-525-2966
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR56791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice