Healthcare Provider Details

I. General information

NPI: 1306837695
Provider Name (Legal Business Name): DENNIS BYRON SOLT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR NORTHWESTERN MEDICAL FACULTY FOUNDATION
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

1581 MANOR LN
PARK RIDGE IL
60068-1586
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-1314
  • Fax:
Mailing address:
  • Phone: 847-692-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: