Provider Demographics
NPI:1124371844
Name:EGAN SOLOMON, BRANDY L (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:L
Last Name:EGAN SOLOMON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 CASITA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3903
Mailing Address - Country:US
Mailing Address - Phone:707-526-5737
Mailing Address - Fax:
Practice Address - Street 1:6543 MONTECITO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2928
Practice Address - Country:US
Practice Address - Phone:707-791-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics