Provider Demographics
NPI:1730235607
Name:SUMMERS, SHAWN J (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:J
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 LARRABEE ST
Mailing Address - Street 2:#10
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2085
Mailing Address - Country:US
Mailing Address - Phone:310-289-9729
Mailing Address - Fax:
Practice Address - Street 1:6801 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5162
Practice Address - Country:US
Practice Address - Phone:818-763-1718
Practice Address - Fax:818-764-4589
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398931223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health