Provider Demographics
NPI:1003038670
Name:MARVIN SOLOMON, D.D.S., P.A.
Entity Type:Organization
Organization Name:MARVIN SOLOMON, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-257-7300
Mailing Address - Street 1:A-3 CORNWALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3352
Mailing Address - Country:US
Mailing Address - Phone:732-257-7300
Mailing Address - Fax:732-257-7316
Practice Address - Street 1:A-3 CORNWALL DRIVE
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3352
Practice Address - Country:US
Practice Address - Phone:732-257-7300
Practice Address - Fax:732-257-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008108001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ168655Medicare ID - Type Unspecified