MEDICARE: JOHN M SOLAK DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	3653	FL

General Provider Information

NPI Number	:	1124169156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M SOLAK DMD PA

Provider Business Mailing Address
First Line	:	3343 W BEARSS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2100
Country	:	US
Telephone Number	:	813-269-2588
Fax Number	:	813-269-4799

Provider Business Practice Location Address
First Line	:	3343 W BEARSS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2100
Country	:	US
Telephone Number	:	813-269-2588
Fax Number	:	813-269-4799

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN MATTHEW SOLAK JR.
Credential	:	DMD
Telephone Number	:	813-269-2588

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	08/22/2020

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