Provider Demographics
NPI:1003683418
Name:DR. NICOLE BUNDY-SOLAK PLLC
Entity Type:Organization
Organization Name:DR. NICOLE BUNDY-SOLAK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BUNDY-SOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:810-247-1314
Mailing Address - Street 1:5313 BRIARCREST DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4025 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7942
Practice Address - Country:US
Practice Address - Phone:810-695-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497370720Medicaid