Provider Demographics
NPI:1043255045
Name:SOMMER, MARSHALL M (DMD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:M
Last Name:SOMMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:SLATERSVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02876
Mailing Address - Country:US
Mailing Address - Phone:401-792-2830
Mailing Address - Fax:401-762-2830
Practice Address - Street 1:900 VICTORY HWY
Practice Address - Street 2:
Practice Address - City:SLATERSVILLE
Practice Address - State:RI
Practice Address - Zip Code:02876
Practice Address - Country:US
Practice Address - Phone:401-762-2830
Practice Address - Fax:401-762-2830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI15651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics