Provider Demographics
NPI:1578303988
Name:SOLARES SILVA, BETHANY ZAHIRA (DDS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ZAHIRA
Last Name:SOLARES SILVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 UNIVERSITY AVE W APT 312
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2022
Mailing Address - Country:US
Mailing Address - Phone:703-895-1095
Mailing Address - Fax:
Practice Address - Street 1:12180 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-4525
Practice Address - Country:US
Practice Address - Phone:763-421-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice