| Organization Name: | SOLO DENTURE AND DENTAL CLINIC INC |
| NPI Number: | 1013381045 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | OLEKSANDR STASYUK (OWNER) |
| Mailing Address: | 7411 196th St Sw Lynnwood |
| State: | WA US |
| Postal Code: | 980365052 |
| Phone Number: | 4256781166 |
| Fax Number: | 4256781167 |
| NPI Enumeration Date: | 11/13/2015 |
| NPI Last Update Date: | 11/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DN60612122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |