| Michael G. Summers Dds, Ms, Pa | |
|
1133 Call Creek Suite B Pocatello ID 83202 | |
| (208) 232-0464 | |
| (208) 232-0863 |
| Full Name | Michael G. Summers Dds, Ms, Pa |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1133 Call Creek, Pocatello, Idaho |
| Authorized Official Name and Position | Michael G. Summers (OWNER) |
| Authorized Official Contact | 2082320464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael G. Summers Dds, Ms, Pa 1133 Call Creek Suite B Pocatello ID 83202 Ph: (208) 232-0464 | Michael G. Summers Dds, Ms, Pa 1133 Call Creek Suite B Pocatello ID 83202 Ph: (208) 232-0464 |
| NPI Number | 1740457332 |
|---|---|
| Provider Enumeration Date | 05/13/2008 |
| Last Update Date | 05/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740457332 | NPI | - | NPPES |
| 963311 | Other | ID | INSURANCE CO. |
| 645574 | Other | ID | UNITED CONCORDIA INS. CO. |
| 6G405 | Other | ID | INSURANCE CO. |
| 9202522 | Medicaid | ID | |
| 963311 | Other | ID | UNITED CONCORDIA INSURANCE CO. |
| 000015300 | Medicaid | ID | |
| 805033500 | Medicaid | ID | |
| 9201874 | Medicaid | ID | |
| 6G421 | Other | ID | INSURANCE CO. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D-3284-OR (Idaho) | Primary |
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