MEDICARE: DR. STEVEN SOLOW DMD 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS019948L	PA
2	1223P0221X	Pediatric Dentistry	DS038347	PA
3	1223P0221X	Pediatric Dentistry	DS019948L	PA

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
2	39253	OTHER	PA	UNITED CONCORDIA
3	20315	OTHER	PA	UNITED CONCORDIA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538550645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. STEVEN SOLOW DMD PC

Provider Business Mailing Address
First Line	:	990 CITY AVE
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-4005
Country	:	US
Telephone Number	:	610-649-8383
Fax Number	:	610-649-5484

Provider Business Practice Location Address
First Line	:	990 CITY AVE
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-4005
Country	:	US
Telephone Number	:	610-649-8383
Fax Number	:	610-649-5484

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN J SOLOW
Credential	:	DMD
Telephone Number	:	610-649-8383

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	04/29/2015

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