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General NPI Number Information
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NPI Number | 1982769592
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Entity Type | Organization
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Legal Business Name | KURT SOLERA DDS PA
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 600 W LANCASHIRE BLVD
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City | BELLA VISTA
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State | AR
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Zip | 72715-0237
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Country | US
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Telephone | 479-855-1855
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Fax | 479-876-1855
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Provider Business Mailing Address
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Address Line | PO BOX 3237
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City | BELLA VISTA
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State | AR
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Zip | 72715-0237
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Country | US
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Telephone | 479-855-1855
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Fax | 479-876-1855
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Authorized Official
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Title or Position | SOLE SHAREHOLDER & OFFICER
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Name | DR. KURT SOLERA
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Credential | DDS
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Telephone | 479-855-1855
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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 | AR
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