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General NPI Number Information
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NPI Number | 1790031342
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Entity Type | Organization
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Legal Business Name | SOL RIVER DENTAL
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 1900 E 14TH ST SUITE C
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City | PLANO
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State | TX
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Zip | 75074-6426
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Country | US
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Telephone | 468-360-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 E 14TH ST SUITE C
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City | PLANO
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State | TX
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Zip | 75074-6426
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Country | US
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Telephone | 468-360-9965
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | PAULA KAY KNIGHT
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Credential | R.D.A.
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Telephone | 817-706-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21106
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License Number State | TX
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