Provider Demographics
NPI:1619056280
Name:SOLOMON, LYNN W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:W
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DDS, MS
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Other - Credentials:
Mailing Address - Street 1:PO BOX 290370
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0370
Mailing Address - Country:US
Mailing Address - Phone:954-262-4346
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:CDM ROOM 7377
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1761
Practice Address - Fax:954-262-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSOLOL1174400000X
MA21786174400000X
FLDN 200251223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV11732Medicare UPIN
MASO-X20167Medicare PIN