MEDICARE: DR. JACOB SOLOMON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN124115	GA
2	122300000X	Dentist	10532	SC

General Provider Information

NPI Number	:	1194401943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB SOLOMON DMD

Provider Business Mailing Address
First Line	:	6 KRIDER CT
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-7807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 TRADERS WAY STE 400
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4300
Country	:	US
Telephone Number	:	912-642-3314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	04/08/2026

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Directions to “ DR. JACOB SOLOMON DMD” Practice Location

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