MEDICARE: DR. PETER MARK SOLOMAN D.D.S.

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	12209	MI

General Provider Information

NPI Number	:	1558462283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MARK SOLOMAN D.D.S.

Provider Business Mailing Address
First Line	:	2490 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-852-2266
Fax Number	:	248-844-0149

Provider Business Practice Location Address
First Line	:	2490 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-852-2266
Fax Number	:	248-844-0149

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/02/2016

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