Provider Demographics
NPI:1154560316
Name:SIGNATURE DENTISTRY
Entity type:Organization
Organization Name:SIGNATURE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-451-1215
Mailing Address - Street 1:11445 E VIA LINDA
Mailing Address - Street 2:STE 2 PMB #612
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2655
Mailing Address - Country:US
Mailing Address - Phone:481-451-1215
Mailing Address - Fax:480-314-4181
Practice Address - Street 1:10855 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:STE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4064
Practice Address - Country:US
Practice Address - Phone:480-451-1215
Practice Address - Fax:480-314-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4325261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental