=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306412531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. MERNA SOLIMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2021
-----------------------------------------------------
Last Update Date | 05/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 W US HIGHWAY 30
-----------------------------------------------------
City | SCHERERVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46375-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-379-8305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15228 RADIANCE DR
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46060-4693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-379-8305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12013601A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------