Provider Demographics
NPI:1699787929
Name:SOMMERS, SCOTT L (DDS)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:L
Last Name:SOMMERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 W GALENA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4482
Mailing Address - Country:US
Mailing Address - Phone:630-892-7041
Mailing Address - Fax:630-892-0241
Practice Address - Street 1:1940 W GALENA BLVD STE 3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4482
Practice Address - Country:US
Practice Address - Phone:630-892-7041
Practice Address - Fax:630-892-0241
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist