Healthcare Provider Details

I. General information

NPI: 1891869590
Provider Name (Legal Business Name): SALOMON ISRAEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 35TH AVE STE A
VERO BEACH FL
32960-2422
US

IV. Provider business mailing address

2025 35TH AVE STE A
VERO BEACH FL
32960-2422
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-2100
  • Fax: 772-569-8827
Mailing address:
  • Phone: 772-569-2100
  • Fax: 772-569-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN0013953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: