Provider Demographics
NPI:1255612396
Name:SOMMER, JENNIFER JANE (RDH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:SOMMER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5S323 BEAU BIEN BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-362-6117
Mailing Address - Fax:
Practice Address - Street 1:931 W. 75TH ST. #107
Practice Address - Street 2:CENTER FOR DENTISTRY
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:630-357-9393
Practice Address - Fax:630-357-9380
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020011078124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist