Provider Demographics
NPI:1790031342
Name:SOL RIVER DENTAL
Entity Type:Organization
Organization Name:SOL RIVER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:817-706-1911
Mailing Address - Street 1:1900 E 14TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6426
Mailing Address - Country:US
Mailing Address - Phone:468-360-9965
Mailing Address - Fax:
Practice Address - Street 1:1900 E 14TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6426
Practice Address - Country:US
Practice Address - Phone:468-360-9965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty