Provider Demographics
NPI:1659605285
Name:SOLTYS LARSON, SARAH MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:SOLTYS LARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14096 STARLITE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-5812
Mailing Address - Country:US
Mailing Address - Phone:763-428-1912
Mailing Address - Fax:
Practice Address - Street 1:14020 NORTHDALE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9612
Practice Address - Country:US
Practice Address - Phone:612-802-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics