Provider Demographics
NPI:1477530541
Name:SOLOMON, BARRY E (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:E
Last Name:SOLOMON
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 1:10000 COORS BYP NW
Mailing Address - Street 2:R G 218
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4040
Mailing Address - Country:US
Mailing Address - Phone:505-242-4867
Mailing Address - Fax:505-890-2883
Practice Address - Street 1:10000 COORS BYP NW
Practice Address - Street 2:R G 218
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4040
Practice Address - Country:US
Practice Address - Phone:505-242-4867
Practice Address - Fax:505-890-2883
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11610Medicaid
NMDD2038OtherDENTAL LICENSE