Provider Demographics
NPI:1144641580
Name:SOLES EXTERMINATING
Entity type:Organization
Organization Name:SOLES EXTERMINATING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-400-4877
Mailing Address - Street 1:12945 SEMINOLE BLVD
Mailing Address - Street 2:STE 9
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2319
Mailing Address - Country:US
Mailing Address - Phone:727-400-4877
Mailing Address - Fax:
Practice Address - Street 1:12945 SEMINOLE BLVD
Practice Address - Street 2:STE 9
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2319
Practice Address - Country:US
Practice Address - Phone:727-400-4877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJF7934171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680033500Medicaid