Provider Demographics
NPI:1871753236
Name:SUMMIT DENTAL PLC
Entity type:Organization
Organization Name:SUMMIT DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:GENETTE BIGELOW
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-462-2212
Mailing Address - Street 1:124 WEST SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-8320
Mailing Address - Country:US
Mailing Address - Phone:515-462-2212
Mailing Address - Fax:515-462-2212
Practice Address - Street 1:124 WEST SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-8320
Practice Address - Country:US
Practice Address - Phone:515-462-2212
Practice Address - Fax:515-462-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty