Provider Demographics
NPI:1689334864
Name:SCHOMMER DENTAL PC
Entity Type:Organization
Organization Name:SCHOMMER DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:563-355-5177
Mailing Address - Street 1:2010 E 38TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1179
Mailing Address - Country:US
Mailing Address - Phone:563-355-5177
Mailing Address - Fax:563-355-0884
Practice Address - Street 1:2010 E 38TH ST STE 105
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1179
Practice Address - Country:US
Practice Address - Phone:563-355-5177
Practice Address - Fax:563-355-0884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHOMMER DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies