Provider Demographics
NPI:1134398019
Name:WIX, SOLITAIRE SHACKLETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:SOLITAIRE
Middle Name:SHACKLETTE
Last Name:WIX
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 1:3650 BOSTON RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1569
Mailing Address - Country:US
Mailing Address - Phone:859-223-7300
Mailing Address - Fax:859-223-1122
Practice Address - Street 1:3650 BOSTON RD
Practice Address - Street 2:SUITE K
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1569
Practice Address - Country:US
Practice Address - Phone:859-223-7300
Practice Address - Fax:859-223-1122
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice