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General NPI Number Information
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NPI Number | 1588137350
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Entity Type | Organization
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Legal Business Name | SOL DENTAL-CANYON PLLC
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 301 N 23RD ST
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City | CANYON
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State | TX
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Zip | 79015-3059
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Country | US
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Telephone | 806-591-1101
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Fax | 806-853-6620
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Provider Business Mailing Address
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Address Line | 1261 W GREEN OAKS BLVD STE 101
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City | ARLINGTON
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State | TX
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Zip | 76013-8349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | TEE SEMERA
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Credential |
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Telephone | 817-809-4865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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