Provider Demographics
NPI:1003855644
Name:SOLTYS, MARK R (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:SOLTYS
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 1:600 WINSLOW WAY E
Mailing Address - Street 2:SUITE L20
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2463
Mailing Address - Country:US
Mailing Address - Phone:206-842-7100
Mailing Address - Fax:
Practice Address - Street 1:600 WINSLOW WAY E
Practice Address - Street 2:SUITE L20
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2463
Practice Address - Country:US
Practice Address - Phone:206-842-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA59131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4104SOOtherINSURANCE PROVIDER
WA07108OtherINSURANCE PROVIDER
WA5100201Medicaid