Provider Demographics
NPI:1689562373
Name:SOLO DENTAL GROUP PLLC
Entity type:Organization
Organization Name:SOLO DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-396-1791
Mailing Address - Street 1:2111 E OAKLAND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5783
Mailing Address - Country:US
Mailing Address - Phone:309-663-6564
Mailing Address - Fax:
Practice Address - Street 1:2111 E OAKLAND AVE STE D
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5783
Practice Address - Country:US
Practice Address - Phone:309-663-6564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty