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General NPI Number Information
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NPI Number | 1376098848
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Entity Type | Organization
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Legal Business Name | JOSHUA SOLOMON DDS MS DENTAL CORP
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 2160 W GRANT LINE RD STE 150
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City | TRACY
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State | CA
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Zip | 95377-7332
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Country | US
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Telephone | 209-832-7906
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Fax | 209-833-1382
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Provider Business Mailing Address
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Address Line | 2160 W GRANT LINE RD STE 150
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City | TRACY
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State | CA
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Zip | 95377-7332
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Country | US
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Telephone | 209-832-7906
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Fax | 209-833-1382
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSHUA SOLOMON
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Credential | DDS, MS
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Telephone | 209-832-7906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 48998
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License Number State | CA
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