Healthcare Provider Details

I. General information

NPI: 1134104110
Provider Name (Legal Business Name): MARSHALL P. SOLOMON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE 4TH FLOOR
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 1262
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2744
  • Fax: 718-270-4567
Mailing address:
  • Phone: 718-270-8867
  • Fax: 718-270-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number028166-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: