MEDICARE: SOLVERE HEALTH CORP.

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

General Provider Information

NPI Number	:	1861063240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLVERE HEALTH CORP.

Provider Business Mailing Address
First Line	:	76 PROGRESS DR STE 123
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3603
Country	:	US
Telephone Number	:	914-835-6004
Fax Number	:	914-560-2216

Provider Business Practice Location Address
First Line	:	76 PROGRESS DR STE 123
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3603
Country	:	US
Telephone Number	:	914-835-6004
Fax Number	:	914-560-2216

Authorized Official
Title or Position	:	COO
Name	:	THEODORE RANDOLPH
Credential	:
Telephone Number	:	914-835-6004

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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Directions to “SOLVERE HEALTH CORP. ” Practice Location

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