Healthcare Provider Details

I. General information

NPI: 1811451776
Provider Name (Legal Business Name): MAILIS DAELIS SOLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR # D1-19
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

3611 SW 34TH ST APT 220
GAINESVILLE FL
32608-6571
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6910
  • Fax:
Mailing address:
  • Phone: 786-427-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: