Individual provider Active NPI

John W Summerville, DMD

  • General Practice Dentistry
  • Essex JCT, VT
National Provider Identifier
1265471247
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
8 Essex Way
Suite 100
Essex JCT, VT 05452-3425
Phone
(802) 879-1233
Fax
(802) 879-3181
NPI assigned
Jun 5, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X VT Primary

Addresses

Primary practice location

8 Essex Way
Suite 100
Essex JCT, VT 05452-3425

Mailing address

8 Essex Way
Suite 100
Essex JCT, VT 05452-3425
Phone (802) 879-1233

Other identifiers 2

IdentifierTypeStateIssuer
SUMM2443OtherVTBCBS
0002443MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150624002768 VT Order and Referring Only - DentistPractitioner - Dentist 8527379098

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
160000828VTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Alderbrook Dental Associates, P.C. General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1265471247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 ESSEX WAY",
            "address_2": "SUITE 100",
            "city": "ESSEX JCT",
            "state": "VT",
            "postal_code": "054523425",
            "telephone_number": "802-879-1233",
            "fax_number": "802-879-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 ESSEX WAY",
            "address_2": "SUITE 100",
            "city": "ESSEX JCT",
            "state": "VT",
            "postal_code": "054523425",
            "telephone_number": "802-879-1233",
            "fax_number": "802-879-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERVILLE",
        "first_name": "JOHN",
        "middle_name": "W",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "SUMM2443",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002443",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Essex JCT, VT

Sources for this page

Verify at the official NPI Registry.