MEDICARE: SOLOMON M LEE DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401410072	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487731105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOMON M LEE DDS PC

Provider Business Mailing Address
First Line	:	3505 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-520-5009
Fax Number	:	804-520-0901

Provider Business Practice Location Address
First Line	:	3505 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-520-5009
Fax Number	:	804-520-0901

Authorized Official
Title or Position	:	PRESIDENT PRINCIPAL
Name	:	DR. SOLOMAN M LEE
Credential	:
Telephone Number	:	804-520-5009

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/18/2008

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