Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1565 | RI |
NPI | 1043255045 |
---|---|
Provider Name | Marshall M Sommer |
First Address | Slatersville, RI 02876 |
Second Address | Slatersville, RI 02876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 08/07/2007 |