Summers, Dwayne Gail
Summers, Dwayne Gail is an individual health care provider with primary practice located at 1365 Douglas Dr , Carbondale IL 62901-2583. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Summers, Dwayne Gail can be contacted via phone (618) 453-2353.Contact Information
Primary practice address
1365 Douglas Dr
Carbondale IL 62901-2583
Phone: (618) 453-2353
Fax: (618) 453-7020
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | Illinois |
Profile Details
| NPI number | 1023008364 |
|---|---|
| LBN Legal business name | Summers, Dwayne Gail |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023008364 | NPPES |
| Illinois | MEDICAID | 1005432 |
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