NPIMap

Organization Active NPI

Summerlin Dental LLC

  • Dentist
  • Indianapolis, IN
National Provider Identifier
1902452055
Registry record updated Aug 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SUMMERLIN DENTAL LLC
Practice address
3351 N Meridian St Ste 105
Indianapolis, IN 46208-4674
Phone
(317) 926-5200
Fax
(317) 947-1663
NPI assigned
Aug 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2019

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

Authorized official

Name
Dr. Jack Donald Summerlin III, DDSNPI 1902053200
Title
Owner
Phone
(317) 926-5200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3351 N Meridian St Ste 105
Indianapolis, IN 46208-4674

Mailing address

3351 N Meridian St Ste 105
Indianapolis, IN 46208-4674
Phone (317) 926-5200

National Provider Directory

National Provider Directory

Locations

3351 N Meridian St
Ste 105
Indianapolis, IN 46208
Phone (317) 926-5200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565740800000",
    "number": "1902452055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 N MERIDIAN ST STE 105",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084674",
            "telephone_number": "317-926-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 N MERIDIAN ST STE 105",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084674",
            "telephone_number": "317-926-5200",
            "fax_number": "317-947-1663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERLIN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-14",
        "last_updated": "2019-08-14",
        "status": "A",
        "authorized_official_last_name": "SUMMERLIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-926-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.