Provider Demographics
NPI:1497894646
Name:SOMROCK, JEFFREY KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:SOMROCK
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 1:22 E CALVARY RD
Mailing Address - Street 2:WOODLAND FAMILY DENTAL CLINIC PA
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803
Mailing Address - Country:US
Mailing Address - Phone:218-724-8227
Mailing Address - Fax:218-724-7808
Practice Address - Street 1:22 E CALVARY RD
Practice Address - Street 2:WOODLAND FAMILY DENTAL CLINIC PA
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803
Practice Address - Country:US
Practice Address - Phone:218-724-8227
Practice Address - Fax:218-724-7808
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist