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General NPI Number Information
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NPI Number | 1467762096
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Entity Type | Organization
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Legal Business Name | SOLIDENTAL MANAGEMENT GROUP, LLC
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Dates
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Enumeration Date | 10/17/2010
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Last Update Date | 10/17/2010
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Provider Practice Location Address
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Address Line | 5521 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4648
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Country | US
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Telephone | 407-490-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 16210 SW 26TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-4408
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Country | US
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Telephone | 407-490-3368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLORIA A BLANCO
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Credential | RDH
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Telephone | 407-490-3368
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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 | DH16998
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License Number State | FL
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