Summit Family Dental Care PC

NPI #1114261104 in Medford, Oregon

Provider Information

NPI Number: 1114261104
Entity Type: Organization
Organization Name: Summit Family Dental Care PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 15, 2012
Last Updated: Nov 19, 2012

Practice Location

Address: 906 ROYAL CT
City: Medford
State: Oregon
ZIP Code: 97504-6139
Phone: (541) 779-2636

Authorized Official

Name: DR. NICOLE LEE KECK-ERICKSON, DMD
Title: DENTIST
Phone: (541) 779-2634

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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