Provider Demographics
NPI:1629113279
Name:SOLIS FAMILY DENTAL PC
Entity type:Organization
Organization Name:SOLIS FAMILY DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-764-4944
Mailing Address - Street 1:515 VALLEY VIEW DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-764-4944
Mailing Address - Fax:309-764-4940
Practice Address - Street 1:515 VALLEY VIEW DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-764-4944
Practice Address - Fax:309-764-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190253391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty