Provider Demographics
NPI:1497815732
Name:SOLTANI, KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:SOLTANI
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 1:801 S WINCHESTER BLVD
Mailing Address - Street 2:#3301
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2902
Mailing Address - Country:US
Mailing Address - Phone:408-569-7400
Mailing Address - Fax:
Practice Address - Street 1:1871 CAMDEN AVE
Practice Address - Street 2:WESTERN DENTAL CENTERS
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2945
Practice Address - Country:US
Practice Address - Phone:408-377-0131
Practice Address - Fax:408-377-0592
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist