Provider Demographics
NPI:1285019935
Name:SOLOMON, RICHARD (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SAN ANTONIO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4128
Mailing Address - Country:US
Mailing Address - Phone:505-273-5363
Mailing Address - Fax:
Practice Address - Street 1:5700 SAN ANTONIO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4128
Practice Address - Country:US
Practice Address - Phone:505-273-5363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist