Provider Demographics
NPI:1801180542
Name:SOLIS, MICHAEL RYAN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:SOLIS
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 1:2305 WORTHINGTON ST APT 121
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2747
Mailing Address - Country:US
Mailing Address - Phone:972-740-5845
Mailing Address - Fax:
Practice Address - Street 1:2321 IRA E WOODS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8632
Practice Address - Country:US
Practice Address - Phone:817-310-5852
Practice Address - Fax:817-310-5922
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice