Provider Demographics
NPI:1972882736
Name:SUMMIT DENTAL LLC
Entity type:Organization
Organization Name:SUMMIT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HULEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-772-3541
Mailing Address - Street 1:1006 EDGEWOOD DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8226
Mailing Address - Country:US
Mailing Address - Phone:574-772-3541
Mailing Address - Fax:
Practice Address - Street 1:1006 S EDGEWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8226
Practice Address - Country:US
Practice Address - Phone:574-772-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty