| Summit Family Dental Care Pc | |
|
906 Royal Ct Medford OR 97504-6139 | |
| (541) 779-2636 | |
| (541) 779-3282 |
| Full Name | Summit Family Dental Care Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 906 Royal Ct, Medford, Oregon |
| Authorized Official Name and Position | Nicole Lee Keck-erickson (DENTIST) |
| Authorized Official Contact | 5417792634 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Family Dental Care Pc 906 Royal Ct Medford OR 97504-6139 Ph: (541) 779-2636 | Summit Family Dental Care Pc 906 Royal Ct Medford OR 97504-6139 Ph: (541) 779-2636 |
| NPI Number | 1114261104 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 11/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114261104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9139 (Oregon) | Primary |
| 1223G0001X | Dentist - General Practice | D9158 (Oregon) | Secondary |
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