Provider Demographics
NPI:1982769592
Name:KURT SOLERA DDS PA
Entity Type:Organization
Organization Name:KURT SOLERA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE SHAREHOLDER & OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-855-1855
Mailing Address - Street 1:PO BOX 3237
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-0237
Mailing Address - Country:US
Mailing Address - Phone:479-855-1855
Mailing Address - Fax:479-876-1855
Practice Address - Street 1:600 W LANCASHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-0237
Practice Address - Country:US
Practice Address - Phone:479-855-1855
Practice Address - Fax:479-876-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty