Summit Dental Lab

Primary specialty

Dental LaboratoryTaxonomy code 292200000X

License

603128257 Issued in WA

Legal business name

SUMMIT DENTAL LAB

Practice address

1590 Woodridge Dr SE
Port Orchard, WA 98366-3818

Phone

(360) 871-2444

NPI assigned

Feb 13, 2017

Organization subpart

No

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

Authorized official

Name

Allen Burleson, CDT

Title

Owner-Dental Lab

Phone

(360) 871-2444

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1518406339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4782 RUTHERFORD CIR SW",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983676430",
            "telephone_number": "360-876-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 WOODRIDGE DR SE",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663818",
            "telephone_number": "360-871-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DENTAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "BURLESON",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER-DENTAL LAB",
        "authorized_official_telephone_number": "360-871-2444",
        "authorized_official_credential": "CDT"
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "WA",
            "license": "603128257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Jo Stump, PTA
• Ginny E Sugimoto, M.D.
• James H Sullivan, PH.D.
• Tracy C Sullivan, DDS
• Danielle Summer, RN
• Sunray Treatment and Recovery
• Susan Putaansuu, MN, Arnp, PLLC
• Susan Putaansuu, MN, Arnp, Pmhnp-BC
• Sarah Anne Sutton, LSWAIC
• Jon R Tacey, LMP

• Dental Laboratory in Port Orchard, WA
• Providers in Port Orchard, WA by specialty
• Dental Laboratory in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; 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.