Provider Demographics
NPI:1871740316
Name:SUMMERS, RENEE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5876 W DRAWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-2830
Mailing Address - Country:US
Mailing Address - Phone:503-544-8415
Mailing Address - Fax:
Practice Address - Street 1:2033 E SUMMERSWEET DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6695
Practice Address - Country:US
Practice Address - Phone:208-331-0182
Practice Address - Fax:208-331-0184
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist