Healthcare Provider Details

I. General information

NPI: 1023697893
Provider Name (Legal Business Name): SHELLY LYNN SOMLAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 K ST NW STE 15B
WASHINGTON DC
20006-1105
US

IV. Provider business mailing address

1990 K ST NW STE 15B
WASHINGTON DC
20006-1105
US

V. Phone/Fax

Practice location:
  • Phone: 202-775-0022
  • Fax: 202-775-3711
Mailing address:
  • Phone: 202-775-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1002158
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: