Provider Demographics
NPI:1437245966
Name:SOLOMON, ROBERT JACKIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JACKIE
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HAZELTINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422
Mailing Address - Country:US
Mailing Address - Phone:610-377-8882
Mailing Address - Fax:
Practice Address - Street 1:300 NORTH YORK ROAD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040
Practice Address - Country:US
Practice Address - Phone:215-675-1404
Practice Address - Fax:215-675-6679
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028628L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice