Provider Demographics
NPI:1538328695
Name:SOLBERG, KIRK HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:HENRY
Last Name:SOLBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAITLAND AVE
Mailing Address - Street 2:1013
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4903
Mailing Address - Country:US
Mailing Address - Phone:407-834-0330
Mailing Address - Fax:
Practice Address - Street 1:201 MAITLAND AVE
Practice Address - Street 2:1013
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4903
Practice Address - Country:US
Practice Address - Phone:407-834-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist