William Summerville, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7658 Issued in NC

Practice address

475 N Wendover Rd
Charlotte, NC 28211-1064

Phone

(704) 540-5400

Fax

(704) 364-5293

NPI assigned

Aug 17, 2006

Last updated

Mar 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• William Summerville DDS PLLC

  dba Distinctive Dentistry of Charlotte

  • General Practice Dentistry
  • Charlotte, NC
  • NPI 1386681625
  NPD

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585267200000",
    "number": "1447364674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 N WENDOVER RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111064",
            "telephone_number": "704-540-5400",
            "fax_number": "704-364-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 N WENDOVER RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111064",
            "telephone_number": "704-540-5400",
            "fax_number": "704-364-5293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERVILLE",
        "first_name": "WILLIAM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "7658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900137",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "9027K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla J Summers, OWNER
• Karen Summers, DDS
• Kisha Denette Summers, LCAS-A, LPC-A
• Shishauna Summerson
• Summerville and Norman PLLC
• Andra R Summey
• Summit Carolinas Consulting LLC
• Summit Medical House Calls, P.C.
• Summit Place of South Park
• Summit Transit Group LLC

• Dentist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; 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.