Healthcare Provider Details

I. General information

NPI: 1083745293
Provider Name (Legal Business Name): SOLON DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E HAGANMAN LN
SOLON IA
52333-9760
US

IV. Provider business mailing address

401 E HAGANMAN LN
SOLON IA
52333-9760
US

V. Phone/Fax

Practice location:
  • Phone: 319-624-4444
  • Fax: 319-624-6178
Mailing address:
  • Phone: 319-624-4444
  • Fax: 319-624-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7713
License Number StateIA

VIII. Authorized Official

Name: MRS. KARI E HAGANMAN
Title or Position: OWNER
Credential: DDS
Phone: 319-624-4444