Provider Demographics
NPI:1205019296
Name:DRS KOMMER AND STURDIVANT PC
Entity Type:Organization
Organization Name:DRS KOMMER AND STURDIVANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:515-225-9245
Mailing Address - Street 1:125 VALLEY WEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3939
Mailing Address - Country:US
Mailing Address - Phone:515-225-9245
Mailing Address - Fax:515-225-8162
Practice Address - Street 1:125 VALLEY WEST DRIVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3939
Practice Address - Country:US
Practice Address - Phone:515-225-9245
Practice Address - Fax:515-225-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0115758Medicaid
IA0081489Medicaid