Healthcare Provider Details

I. General information

NPI: 1245580877
Provider Name (Legal Business Name): RICHARD CHRISTIAN SOLEM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE # D-3000
SAN FRANCISCO CA
94143-0438
US

IV. Provider business mailing address

882 PRESIDIO AVE
SAN FRANCISCO CA
94115-2921
US

V. Phone/Fax

Practice location:
  • Phone: 949-838-6903
  • Fax: 415-514-0377
Mailing address:
  • Phone: 949-838-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: