Provider Demographics
NPI:1962052035
Name:SUMMIT AESTHETICS LLC
Entity type:Organization
Organization Name:SUMMIT AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KUERSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-787-0701
Mailing Address - Street 1:34209 N. SCOTTSDALE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266
Mailing Address - Country:US
Mailing Address - Phone:480-787-0701
Mailing Address - Fax:480-393-7439
Practice Address - Street 1:34209 N. SCOTTSDALE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266
Practice Address - Country:US
Practice Address - Phone:480-787-0701
Practice Address - Fax:480-393-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty