Provider Demographics
NPI:1588821151
Name:BLUMENFELD, SOL (DDS)
Entity type:Individual
Prefix:DR
First Name:SOL
Middle Name:
Last Name:BLUMENFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SOL
Other - Middle Name:
Other - Last Name:BLUMENFELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15742 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3036
Mailing Address - Country:US
Mailing Address - Phone:248-557-2120
Mailing Address - Fax:
Practice Address - Street 1:17040 W 12 MILE RD
Practice Address - Street 2:150
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2131
Practice Address - Country:US
Practice Address - Phone:248-559-0995
Practice Address - Fax:248-559-6724
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist