Provider Demographics
NPI:1598598914
Name:SOMERS DENTAL LLC
Entity type:Organization
Organization Name:SOMERS DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDALITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-454-7655
Mailing Address - Street 1:1363 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2967
Mailing Address - Country:US
Mailing Address - Phone:630-885-1131
Mailing Address - Fax:
Practice Address - Street 1:1311 BUTTERFIELD RD STE 111
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-8945
Practice Address - Country:US
Practice Address - Phone:630-454-7655
Practice Address - Fax:331-232-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental