Provider Demographics
NPI:1093929911
Name:SOLAR, CAMILO R
Entity Type:Individual
Prefix:DR
First Name:CAMILO
Middle Name:R
Last Name:SOLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:REINALDO
Other - Middle Name:C
Other - Last Name:SOLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:86 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1004
Mailing Address - Country:US
Mailing Address - Phone:201-342-0894
Mailing Address - Fax:201-342-0894
Practice Address - Street 1:421 59TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2107
Practice Address - Country:US
Practice Address - Phone:201-869-3407
Practice Address - Fax:201-869-3407
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ092101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5170102Medicaid