Provider Demographics
NPI:1467762096
Name:SOLIDENTAL MANAGEMENT GROUP, LLC
Entity Type:Organization
Organization Name:SOLIDENTAL MANAGEMENT GROUP, LLC
Other - Org Name:NEWDENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:407-490-3368
Mailing Address - Street 1:16210 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4408
Mailing Address - Country:US
Mailing Address - Phone:407-490-3368
Mailing Address - Fax:
Practice Address - Street 1:5521 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4648
Practice Address - Country:US
Practice Address - Phone:407-490-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-17
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH16998261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental