Provider Demographics
NPI:1629705025
Name:SOLARES, MARISSA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:SOLARES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:SOLARES ROSSATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:16104 KILMARNOCK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6518
Mailing Address - Country:US
Mailing Address - Phone:305-989-8507
Mailing Address - Fax:
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:305-989-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty