Provider Demographics
NPI:1205121662
Name:SOMMER, NATHAN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WILLIAM
Last Name:SOMMER
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 1:2401 TRIFLE LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5306
Mailing Address - Country:US
Mailing Address - Phone:402-541-3073
Mailing Address - Fax:
Practice Address - Street 1:12244 WAKE UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9549
Practice Address - Country:US
Practice Address - Phone:919-556-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6954122300000X
NC116581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist