Provider Demographics
NPI:1811907033
Name:SOLOMON, GREG (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:
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 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:207-945-5952
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-945-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME33831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice