Provider Demographics
NPI:1124169156
Name:JOHN M SOLAK DMD PA
Entity type:Organization
Organization Name:JOHN M SOLAK DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SOLAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-269-2588
Mailing Address - Street 1:3343 W BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2100
Mailing Address - Country:US
Mailing Address - Phone:813-269-2588
Mailing Address - Fax:813-269-4799
Practice Address - Street 1:3343 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2100
Practice Address - Country:US
Practice Address - Phone:813-269-2588
Practice Address - Fax:813-269-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3653261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental