Provider Demographics
NPI:1184037699
Name:SOLVERSON, MITCHELL KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:KENT
Last Name:SOLVERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1937
Mailing Address - Country:US
Mailing Address - Phone:248-651-8787
Mailing Address - Fax:
Practice Address - Street 1:310 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1937
Practice Address - Country:US
Practice Address - Phone:248-651-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist