Active NPI
Summer Gavin
- Dentist
- Wilkes Barre, PA
National Provider Identifier
1093663445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401419891
- Practice address
- 1111 E End Blvd
Wilkes Barre, PA 18711-0030 - Phone
- (570) 824-3521
- NPI assigned
- Mar 20, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401419891 | VA | Primary |
Addresses
Primary practice location
1111 E End Blvd
Wilkes Barre, PA 18711-0030
Mailing address
233 Hemlock Ter
Mountain Top, PA 18707-1530
Phone (570) 259-7603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401419891 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773964800000",
"number": "1093663445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 HEMLOCK TER",
"city": "MOUNTAIN TOP",
"state": "PA",
"postal_code": "187071530",
"telephone_number": "570-259-7603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 E END BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110030",
"telephone_number": "570-824-3521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "SUMMER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-03-20",
"last_updated": "2026-03-20",
"certification_date": "2026-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401419891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.