Provider Demographics
NPI:1336170265
Name:SOLLOM, DENNIS G (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:SOLLOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5279208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND681203100Medicaid
ND126895OtherUCARE #
ND911595OtherAMERICA'S PPO/ARAZ #
NDHP25769OtherHEALTHPARTNERS #
NDND200062OtherLHS #
ND2300159OtherMEDICA #
ND15146Medicaid
ND2300113OtherMEDICA #
NDDA9011015590OtherPREFERRED ONE #
ND16583SOOtherMNBS #
ND2222OtherNDBS #
NDAS2097079OtherDEA #
NDD64094Medicare UPIN
ND15146Medicaid
ND2300159OtherMEDICA #