MEDICARE: DR. DUSTIN R SOLIS DDS

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	122300000X	Dentist	053183	NY

General Provider Information

NPI Number	:	1730382367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN R SOLIS DDS

Provider Business Mailing Address
First Line	:	268 ROOSEVELT AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-5412
Country	:	US
Telephone Number	:	516-868-2680
Fax Number	:	516-868-2680

Provider Business Practice Location Address
First Line	:	82 JUDITH CT
Second Line	:
City	:	EAST ROCKAWAY
State	:	NY
Zip	:	11518-1630
Country	:	US
Telephone Number	:	516-593-2720
Fax Number	:	516-593-5048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2007
Last Update Date	:	07/08/2007

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