Summit Park Dental, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

ND14668 Issued in FL

Legal business name

SUMMIT PARK DENTAL, INC

Practice address

723 CR 466
Lady Lake, FL 32159

Phone

(352) 430-0543

Fax

(352) 430-0702

NPI assigned

Sep 26, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Phuong Ta

Title

President / Owner

Phone

(352) 255-5538

Specialties & licenses 1

Addresses

Other names 1

• Lake Quality Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348617600000",
    "number": "1053662395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 CHINAHILL CT",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "32712",
            "telephone_number": "352-430-0543",
            "fax_number": "352-430-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 CR 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "32159",
            "telephone_number": "352-430-0543",
            "fax_number": "352-430-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PARK DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-26",
        "last_updated": "2012-09-26",
        "status": "A",
        "authorized_official_last_name": "TA",
        "authorized_official_first_name": "PHUONG",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "352-255-5538"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "ND14668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Quality Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie Louise Stoneham, LCSW
• Megan Leigh Stout, AU.D.
• Mark Christopher Strickland, APRN
• Ashley Brooke Suarez, APRN
• Leonard A Sudberg, MD
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• Surgical Practice Resource Group of Florida Inc

• Dentist in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.