Provider Demographics
NPI:1528150364
Name:BOMMER, JOHN R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BOMMER
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:442 W HIGH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1681
Mailing Address - Country:US
Mailing Address - Phone:419-636-3163
Mailing Address - Fax:419-636-5037
Practice Address - Street 1:442 W HIGH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1681
Practice Address - Country:US
Practice Address - Phone:419-636-3163
Practice Address - Fax:419-636-5037
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH300145121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30014512OtherJOHN BOMMER-DELTA DENTAL
OH0278097Medicaid
OH402257OtherUCCI - JOHN BOMMER