Provider Demographics
NPI:1740558865
Name:SOLOMON, LESLIE A (DDS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3340
Mailing Address - Country:US
Mailing Address - Phone:805-498-3661
Mailing Address - Fax:805-498-2968
Practice Address - Street 1:2245 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3340
Practice Address - Country:US
Practice Address - Phone:805-498-3661
Practice Address - Fax:805-498-2968
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist