Provider Demographics
NPI:1649279597
Name:SOMMER, STEPHANIE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SOMMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 MINSTER FORT RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-9797
Mailing Address - Country:US
Mailing Address - Phone:419-305-7238
Mailing Address - Fax:
Practice Address - Street 1:10484 KLEY RD STE E
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9611
Practice Address - Country:US
Practice Address - Phone:937-526-5858
Practice Address - Fax:937-526-3350
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist