Provider Demographics
NPI:1952502148
Name:SOLOMON, STEVEN J (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
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 1:56 KITCHAWAN RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-1314
Mailing Address - Country:US
Mailing Address - Phone:914-450-5164
Mailing Address - Fax:914-764-8374
Practice Address - Street 1:56 KITCHAWAN RD
Practice Address - Street 2:
Practice Address - City:POUND RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10576-1314
Practice Address - Country:US
Practice Address - Phone:914-450-5164
Practice Address - Fax:914-764-8374
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0375671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00844106Medicaid