Healthcare Provider Details

I. General information

NPI: 1285019935
Provider Name (Legal Business Name): RICHARD SOLOMON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 SAN ANTONIO DR NE
ALBUQUERQUE NM
87109-4128
US

IV. Provider business mailing address

5700 SAN ANTONIO DR NE
ALBUQUERQUE NM
87109-4128
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-5363
  • Fax:
Mailing address:
  • Phone: 505-273-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4353
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: