Individual provider Active NPI

Dorian Solomon

  • Dentist
  • Fort Myers, FL
National Provider Identifier
1740606748
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN20526 Issued in FL
Practice address
2232 Grand Ave
Fort Myers, FL 33901-3717
Phone
(239) 344-2344
Fax
(239) 332-3372
NPI assigned
Mar 14, 2014
Last updated
Aug 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN20526 FL Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 0401418773 VA
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 17589 MD
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 30.027033 OH

Addresses

Primary practice location

2232 Grand Ave
Fort Myers, FL 33901-3717

Mailing address

PO Box 1357
Fort Myers, FL 33902-1357
Phone (239) 278-3600

Other identifiers 1

IdentifierTypeStateIssuer
011673600MedicaidFL

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
I20151208000521 FL Order and Referring Only - DentistPractitioner - Dentist 5294035648

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN20526FLMDDentist
17589MDMDOrthodontics and Dentofacial Orthopedic Dentist
30.027033OHMDOrthodontics and Dentofacial Orthopedic Dentist
0401418773VAMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1740606748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1357",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339021357",
            "telephone_number": "239-278-3600",
            "fax_number": "239-226-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 GRAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339013717",
            "telephone_number": "239-344-2344",
            "fax_number": "239-332-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLOMON",
        "first_name": "DORIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-14",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20526",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "0401418773",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MD",
            "license": "17589",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OH",
            "license": "30.027033",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011673600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.