Provider Demographics
NPI:1740328988
Name:SOLOMON, SELIG KERMIT (DMD)
Entity type:Individual
Prefix:DR
First Name:SELIG
Middle Name:KERMIT
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ZELIG
Other - Middle Name:KERMIT
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:144 12 76 AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3116
Mailing Address - Country:US
Mailing Address - Phone:718-793-4200
Mailing Address - Fax:
Practice Address - Street 1:144 12 76 AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3116
Practice Address - Country:US
Practice Address - Phone:718-793-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics