Healthcare Provider Details

I. General information

NPI: 1043255045
Provider Name (Legal Business Name): MARSHALL M SOMMER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VICTORY HWY
SLATERSVILLE RI
02876
US

IV. Provider business mailing address

PO BOX 1157
SLATERSVILLE RI
02876
US

V. Phone/Fax

Practice location:
  • Phone: 401-762-2830
  • Fax: 401-762-2830
Mailing address:
  • Phone: 401-792-2830
  • Fax: 401-762-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1565
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: