MEDICARE: DR. MARC B SOLOMON 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	1223G0001X	General Practice Dentistry	026116	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669463873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC B SOLOMON D.D.S.

Provider Business Mailing Address
First Line	:	434 MADEIRA BLVD
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-5212
Country	:	US
Telephone Number	:	631-367-3679
Fax Number	:	631-367-3608

Provider Business Practice Location Address
First Line	:	1690 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5605
Country	:	US
Telephone Number	:	718-342-0391
Fax Number	:	631-367-3608

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	02/04/2008

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