Solomon T Woldesilassie, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

5068 Issued in AZ

Practice address

26224 N Tatum Blvd
Suit # 10
Phoenix, AZ 85050-7500

Phone

(480) 563-4173

Fax

(480) 563-5019

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Solomon T. Woldesilassie, DDS, PC

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1174770085
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710095799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26224 N TATUM BLVD",
            "address_2": "SUIT # 10",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507500",
            "telephone_number": "480-563-4173",
            "fax_number": "480-563-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26224 N TATUM BLVD",
            "address_2": "SUIT # 10",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507500",
            "telephone_number": "480-563-4173",
            "fax_number": "480-563-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLDESILASSIE",
        "first_name": "SOLOMON",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "5068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AZ",
            "identifier": "AZ0499860",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY CARE (AHCCCS)",
            "identifier": "694548",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "700534",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA OF AZ",
            "identifier": "5005068",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Rose Wojcik, OTD
• Mary M Wojnakowski, CRNA
• Laura Beth Wojtalewicz
• Travis Christian Wolanski
• Brittany Wold
• Benjamin Wolf, OTR/L
• Caitlyn Wolf
• Eli Wolf, FNP-C
• Elisabeth Wolf
• Erin C Wolf, PA-C

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.