Provider Demographics
NPI:1588903447
Name:SOLOMON DENTAL COPRORATION
Entity type:Organization
Organization Name:SOLOMON DENTAL COPRORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-424-2990
Mailing Address - Street 1:175 E. BROWN ST. SUITE 112
Mailing Address - Street 2:POCONO MEDICAL BLDG.- SOLOMON DENTAL CORP.
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-424-2990
Mailing Address - Fax:570-424-8174
Practice Address - Street 1:175 E. BROWN ST. SUITE 112
Practice Address - Street 2:POCONO MEDICAL BLDG.- SOLOMON DENTAL CORP.
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-424-2990
Practice Address - Fax:570-424-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021131R122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty