MEDICARE: DR. DOUGLAS SOLOW DDS, MBA

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	38792	NY
2	122300000X	Dentist	101081	CA

General Provider Information

NPI Number	:	1790853570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS SOLOW DDS, MBA

Provider Business Mailing Address
First Line	:	925 W 34TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-1093
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 W 34TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-1093
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	04/24/2017

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