Provider Demographics
NPI:1306035159
Name:SOMMERS, NORMAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:C
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 1:72 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857
Mailing Address - Country:US
Mailing Address - Phone:419-668-3606
Mailing Address - Fax:419-663-8537
Practice Address - Street 1:72 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:419-668-3606
Practice Address - Fax:419-663-8537
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020496332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306994Medicaid