Provider Demographics
NPI:1780024950
Name:SOLIS GONZALEZ, ELENA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIA
Last Name:SOLIS GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 NW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2947
Mailing Address - Country:US
Mailing Address - Phone:561-267-0906
Mailing Address - Fax:
Practice Address - Street 1:19151 S DIXIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7737
Practice Address - Country:US
Practice Address - Phone:305-256-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN202401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice