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General NPI Number Information
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NPI Number | 1104336049
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Entity Type | Organization
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Legal Business Name | SOLT FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 1535 44TH ST SW STE 200
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City | WYOMING
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State | MI
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Zip | 49509-4481
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Country | US
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Telephone | 616-531-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 2662 PARKVIEW CT
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City | WATERFORD
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State | MI
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Zip | 48329-3671
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Country | US
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Telephone | 810-338-0656
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KEVIN TIMOTHY SOLT
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Credential | DDS
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Telephone | 810-338-0656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901021009
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License Number State | MI
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