Provider Demographics
NPI:1902182793
Name:DR. SOLIS DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR. SOLIS DENTAL CORPORATION
Other - Org Name:PARADISE SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-257-9909
Mailing Address - Street 1:29491 THE OLD RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-2902
Mailing Address - Country:US
Mailing Address - Phone:661-257-9909
Mailing Address - Fax:661-257-0008
Practice Address - Street 1:29491 THE OLD RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-2902
Practice Address - Country:US
Practice Address - Phone:661-257-9909
Practice Address - Fax:661-257-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43660305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization