Provider Demographics
NPI:1275962300
Name:SOLOMON, RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:IGOR
Other - Middle Name:
Other - Last Name:SOLOVEYCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:908 W MARGATE TER # 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3810
Mailing Address - Country:US
Mailing Address - Phone:773-330-9025
Mailing Address - Fax:
Practice Address - Street 1:908 W MARGATE TER # 1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3810
Practice Address - Country:US
Practice Address - Phone:773-330-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist