Provider Demographics
NPI:1114085412
Name:PAUL R SOMMERS DDS SC
Entity Type:Organization
Organization Name:PAUL R SOMMERS DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-261-5110
Mailing Address - Street 1:121 OAKRIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094
Mailing Address - Country:US
Mailing Address - Phone:920-261-5110
Mailing Address - Fax:920-261-5735
Practice Address - Street 1:121 OAKRIDGE COURT
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-261-5110
Practice Address - Fax:920-261-5735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
33386400OtherMEDICAL ASSISTANCE BADGER