Provider Demographics
NPI:1639593163
Name:SOLLER, DOMINIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:SOLLER
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 1:24261 AVENIDA DE LA CARLOTA STE Q4
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7633
Mailing Address - Country:US
Mailing Address - Phone:949-951-7800
Mailing Address - Fax:949-855-1237
Practice Address - Street 1:24261 AVENIDA DE LA CARLOTA STE Q4
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7633
Practice Address - Country:US
Practice Address - Phone:949-951-7800
Practice Address - Fax:949-855-1237
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist