Organization
SOLOMON ORAL SURGERY LLC
Active
Parent organization
A. FREDERICK SOLOMON DMD P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
A. FREDERICK SOLOMON DMD P.A.
Authorized official
ANGELA BAZZLE (OPERATIONS MANAGER)
(843) 871-0843
Entity
Organization
Contact information
Practice address
3102 N HIGHWAY 17, MOUNT PLEASANT, SC 29466-6925
(843) 871-0842
Mailing address
1971 N MAIN ST, SUMMERVILLE, SC 29486-7890
(843) 871-0842
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8797
—
SC
05
—
ZX9601
—
SC
Enumeration date
01/25/2021
Last updated
01/25/2021
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