Provider Demographics
NPI:1780160333
Name:SOMERS, KELLY HENNESSEY (DDS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:HENNESSEY
Last Name:SOMERS
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 1:3615 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2624
Mailing Address - Country:US
Mailing Address - Phone:509-456-8676
Mailing Address - Fax:509-456-8678
Practice Address - Street 1:3615 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2624
Practice Address - Country:US
Practice Address - Phone:509-456-8676
Practice Address - Fax:509-456-8679
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60861734122300000X
WA608617341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist