Provider Demographics
NPI:1780800789
Name:SOLT, BRYAN TED (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:TED
Last Name:SOLT
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 1:51772 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4450
Mailing Address - Country:US
Mailing Address - Phone:586-726-6940
Mailing Address - Fax:586-726-8449
Practice Address - Street 1:51772 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4450
Practice Address - Country:US
Practice Address - Phone:586-726-6940
Practice Address - Fax:586-726-8449
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0150971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice