Provider Demographics
NPI:1063585396
Name:SOLIS, LOURDES ROCIO (DDS)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:ROCIO
Last Name:SOLIS
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 1:426 E DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3018
Mailing Address - Country:US
Mailing Address - Phone:301-990-8435
Mailing Address - Fax:301-990-4218
Practice Address - Street 1:426 E DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3018
Practice Address - Country:US
Practice Address - Phone:301-990-8435
Practice Address - Fax:301-990-4218
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice