Individual
DR. STACY LEIGH SOLOMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2021 S E ST, STE #5, BROKEN BOW, NE 68822-1848
(308) 767-2004
(308) 767-2006
Mailing address
2021 S E ST, STE #5, BROKEN BOW, NE 68822-1848
(308) 767-2004
(308) 767-2006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6515
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05178
BCBS
NE
05
—
10025242100
—
NE
Enumeration date
11/09/2006
Last updated
01/25/2012
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