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General NPI Number Information
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NPI Number | 1053481606
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Entity Type | Organization
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Legal Business Name | SOLOMON FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 544 MCCARTY ST
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City | MERNA
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State | NE
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Zip | 68856-0327
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Country | US
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Telephone | 308-643-2679
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Fax | 308-643-2684
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Provider Business Mailing Address
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Address Line | PO BOX 327
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City | MERNA
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State | NE
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Zip | 68856-0327
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Country | US
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Telephone | 308-643-2679
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Fax | 308-643-2684
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STACY L SOLOMON
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Credential | D.D.S.
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Telephone | 308-643-2679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6515
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License Number State | NE
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