Provider Demographics
NPI:1477248532
Name:SOLIS PENA, CARLOS ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ANTONIO
Last Name:SOLIS PENA
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 1:19013 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3925
Mailing Address - Country:US
Mailing Address - Phone:818-943-1625
Mailing Address - Fax:
Practice Address - Street 1:14435 HAMLIN ST STE 101
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-988-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist