Individual provider Active NPI

Solomon G Brotman, D.D.S.

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1619006517
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN9407 Issued in FL
Practice address
3647 Hendricks Ave
Jacksonville, FL 32207-5360
Phone
(904) 396-4091
Fax
(904) 396-9091
NPI assigned
Mar 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN9407 FL Primary

Addresses

Primary practice location

3647 Hendricks Ave
Jacksonville, FL 32207-5360

Mailing address

3647 Hendricks Ave
Jacksonville, FL 32207-5360
Phone (904) 396-4091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150409002449 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2264652791

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN9407FLMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619006517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3647 HENDRICKS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075360",
            "telephone_number": "904-396-4091",
            "fax_number": "904-396-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3647 HENDRICKS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075360",
            "telephone_number": "904-396-4091",
            "fax_number": "904-396-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTMAN",
        "first_name": "SOLOMON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN9407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.