Provider Demographics
NPI:1295103208
Name:DUSTIN R. SOLIS DDS PLLC
Entity type:Organization
Organization Name:DUSTIN R. SOLIS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-307-1050
Mailing Address - Street 1:192 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1723
Mailing Address - Country:US
Mailing Address - Phone:516-307-1050
Mailing Address - Fax:
Practice Address - Street 1:192 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1723
Practice Address - Country:US
Practice Address - Phone:516-307-1050
Practice Address - Fax:516-307-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty