Provider Demographics
NPI:1871617548
Name:SOLIS, KEVIN J (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:SOLIS
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 1:515 VALLEY VIEW DRIVE
Mailing Address - Street 2:STE 105
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-764-4944
Mailing Address - Fax:309-764-4940
Practice Address - Street 1:515 VALLEY VIEW DRIVE
Practice Address - Street 2:STE 105
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-764-4944
Practice Address - Fax:309-764-4940
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190253391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice