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Individual

DR. SOLOMON T WOLDESILASSIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
26224 N TATUM BLVD, SUIT # 10, PHOENIX, AZ 85050-7500
(480) 563-4173
(480) 563-5019
Mailing address
26224 N TATUM BLVD, SUIT # 10, PHOENIX, AZ 85050-7500
(480) 563-4173
(480) 563-5019

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5068
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5005068
DELTA OF AZ
AZ
01
694548
MERCY CARE (AHCCCS)
AZ
01
700534
UNITED CONCORDIA
AZ
01
AZ0499860
BCBS OF AZ
AZ
Enumeration date
08/29/2006
Last updated
07/08/2007
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