Provider Demographics
NPI:1477610251
Name:SOLOMON, SID (DDS)
Entity Type:Individual
Prefix:DR
First Name:SID
Middle Name:
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 1:1620 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5604
Mailing Address - Country:US
Mailing Address - Phone:310-475-5598
Mailing Address - Fax:310-475-1970
Practice Address - Street 1:1620 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5604
Practice Address - Country:US
Practice Address - Phone:310-475-5598
Practice Address - Fax:310-475-1970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice