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General NPI Number Information
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NPI Number | 1588903447
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Entity Type | Organization
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Legal Business Name | SOLOMON DENTAL COPRORATION
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 175 E. BROWN ST. SUITE 112 POCONO MEDICAL BLDG.- SOLOMON DENTAL CORP.
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-424-2990
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Fax | 570-424-8174
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Provider Business Mailing Address
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Address Line | 175 E. BROWN ST. SUITE 112 POCONO MEDICAL BLDG.- SOLOMON DENTAL CORP.
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-424-2990
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Fax | 570-424-8174
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL DAVID SOLOMON
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Credential | DDS
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Telephone | 570-424-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 021131R
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License Number State | PA
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