Provider Demographics
NPI:1063763761
Name:SOMMERCORN, LINDA M (MS, DDS, RPH)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:SOMMERCORN
Suffix:
Gender:F
Credentials:MS, DDS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31134 PRAIRIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4898
Mailing Address - Country:US
Mailing Address - Phone:847-367-8084
Mailing Address - Fax:847-367-8094
Practice Address - Street 1:1216 AMERICAN WAY STE 104
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3940
Practice Address - Country:US
Practice Address - Phone:847-367-8084
Practice Address - Fax:847-367-8722
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021396122300000X
IL0210019221223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice