Healthcare Provider Details

I. General information

NPI: 1942622055
Provider Name (Legal Business Name): SOMMERS ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY STE 17
MINOT ND
58701-4667
US

IV. Provider business mailing address

1015 S BROADWAY STE 17
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-2646
  • Fax: 701-839-1019
Mailing address:
  • Phone: 701-852-2646
  • Fax: 701-839-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1550
License Number StateND

VIII. Authorized Official

Name: DR. DENNIS D SOMMERS
Title or Position: OWNER
Credential: DDS
Phone: 701-852-2646