Provider Demographics
NPI:1992862742
Name:SOLOMON, ALWYN FREDERICK (DMD)
Entity type:Individual
Prefix:DR
First Name:ALWYN
Middle Name:FREDERICK
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:FREDERICK
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1971 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483
Mailing Address - Country:US
Mailing Address - Phone:843-871-0842
Mailing Address - Fax:843-832-4531
Practice Address - Street 1:1971 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-871-0842
Practice Address - Fax:843-832-4531
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC23011223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC409001Medicaid