MEDICARE: DR. JENNIFER PHAM SOMORAY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	16850	MD
2	1223P0700X	Prosthodontics	26322	FL

General Provider Information

NPI Number	:	1376170266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER PHAM SOMORAY DDS

Provider Business Mailing Address
First Line	:	2180 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4236
Country	:	US
Telephone Number	:	321-452-3388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4236
Country	:	US
Telephone Number	:	321-452-3388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	04/09/2026

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