Provider Demographics
NPI:1922569318
Name:ISAKOV, SOLOMON (DMD)
Entity type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:
Last Name:ISAKOV
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 1:2640 W MARKET ST STE 302
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4202
Mailing Address - Country:US
Mailing Address - Phone:330-835-1000
Mailing Address - Fax:
Practice Address - Street 1:2640 W MARKET ST STE 302
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4202
Practice Address - Country:US
Practice Address - Phone:330-835-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0260831223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty