Provider Demographics
NPI:1902999303
Name:SOLIS, DIEGO ALONSO (DDS)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:ALONSO
Last Name:SOLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 SCIOTO STATION DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3696
Mailing Address - Country:US
Mailing Address - Phone:614-477-6368
Mailing Address - Fax:
Practice Address - Street 1:2879 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-342-5795
Practice Address - Fax:614-642-5804
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH710001781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2671087Medicaid