Individual provider Active NPI

Clayton Schommer, DMD

  • General Practice Dentistry
  • Davenport, IA
National Provider Identifier
1679039002
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9438 Issued in IA
Practice address
2010 E 38TH St Ste 105
Davenport, IA 52807-1179
Phone
(563) 355-5177
NPI assigned
Feb 11, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 9438 IA Primary

Addresses

Primary practice location

2010 E 38TH St Ste 105
Davenport, IA 52807-1179

Mailing address

5014 Leprechaun Dr
Davenport, IA 52807-7613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9438IAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Schommer Dental PC CurrentSince Jan 2, 2022 Accepting new patients

Locations

2010 E 38th St
Ste 105
Davenport, IA 52807
Phone (563) 355-5177

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1679039002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5014 LEPRECHAUN DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528077613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 E 38TH ST STE 105",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071179",
            "telephone_number": "563-355-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHOMMER",
        "first_name": "CLAYTON",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-11",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "9438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.