Summit Family Dental Care PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9139 Issued in OR

Legal business name

SUMMIT FAMILY DENTAL CARE PC

Practice address

906 Royal CT
Medford, OR 97504-6139

Phone

(541) 779-2636

Fax

(541) 779-3282

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Nicole Lee Keck-Erickson, DMD

Title

Dentist

Phone

(541) 779-2634

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353283200000",
    "number": "1114261104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 ROYAL CT",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046139",
            "telephone_number": "541-779-2636",
            "fax_number": "541-779-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 ROYAL CT",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046139",
            "telephone_number": "541-779-2636",
            "fax_number": "541-779-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT FAMILY DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-19",
        "status": "A",
        "authorized_official_last_name": "KECK-ERICKSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "541-779-2634",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9139",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9158",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Jane Sullivan
• Summer Waters, LLC
• Brett A. Summers, R.PH
• Robin Lynn Nicole Summers
• Summit Dermatology and Aesthetics
• Summit View Therapy LLC
• Archana N Sundar
• Tammy Eileen Surbrook
• Nandita Suresh, MD
• Surgery Center of Southern Oregon, LLC

• General Practice Dentistry in Medford, OR
• Providers in Medford, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.