Provider Demographics
NPI:1730249152
Name:DENTAL DESIGNS OF SOLOMON VALLEY, P.A.
Entity type:Organization
Organization Name:DENTAL DESIGNS OF SOLOMON VALLEY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-738-3758
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-0466
Mailing Address - Country:US
Mailing Address - Phone:785-738-3758
Mailing Address - Fax:785-738-2737
Practice Address - Street 1:208 S MILL ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-3239
Practice Address - Country:US
Practice Address - Phone:785-738-3758
Practice Address - Fax:785-738-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS420778OtherBCBS OF KS COMMON PAY #