Provider Demographics
NPI:1386185882
Name:BLISKO, SOLOMON (DDS)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:BLISKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 SILVER CT
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2930
Mailing Address - Country:US
Mailing Address - Phone:516-374-3977
Mailing Address - Fax:
Practice Address - Street 1:370 SILVER CT
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2930
Practice Address - Country:US
Practice Address - Phone:516-374-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist