MEDICARE: SOLA DENTAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	24649	TX

General Provider Information

NPI Number	:	1366799603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLA DENTAL, PLLC

Provider Business Mailing Address
First Line	:	300 S LAMAR BLVD
Second Line	:	SUITE N
City	:	AUSTIN
State	:	TX
Zip	:	78704-1055
Country	:	US
Telephone Number	:	512-983-5605
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S LAMAR BLVD
Second Line	:	SUITE N
City	:	AUSTIN
State	:	TX
Zip	:	78704-1055
Country	:	US
Telephone Number	:	512-983-5605
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. THOMAS CHARLES GENT
Credential	:	DDS
Telephone Number	:	512-614-6800

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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