Provider Demographics
NPI:1770776593
Name:DOMINIC SOLLER DDS INC
Entity type:Organization
Organization Name:DOMINIC SOLLER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:CABOTAJE
Authorized Official - Last Name:SOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-951-7800
Mailing Address - Street 1:24351 AVE DE LA CARLOTA #N4
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-951-7800
Mailing Address - Fax:949-855-1237
Practice Address - Street 1:24351 AVE DE LA CARLOTA #N4
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-951-7800
Practice Address - Fax:949-855-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49218OtherCALIFORNIA DENTAL BOARD
CAB57640053OtherDEA