NPIMap

Organization Active NPI

Frederick a. Port, DMD & Greg S. Solomon, DDS, PA

  • General Practice Dentistry
  • Bangor, ME
National Provider Identifier
1972513190
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FREDERICK A. PORT, DMD & GREG S. SOLOMON, DDS, PA
Practice address
700 Mount Hope Ave
Suite 610
Bangor, ME 04401-5691
Phone
(207) 945-5952
NPI assigned
Aug 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Greg Solomon, DDSNPI 1811907033
Title
President
Phone
(207) 945-5952

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

700 Mount Hope Ave
Suite 610
Bangor, ME 04401-5691

Mailing address

700 Mount Hope Ave
Suite 610
Bangor, ME 04401-5691

Other identifiers 1

IdentifierTypeStateIssuer
10909000MedicaidME

National Provider Directory

National Provider Directory

Locations

700 Mount Hope Ave
Ste 610
Bangor, ME 04401
Phone (207) 945-5952

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972513190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 MOUNT HOPE AVE",
            "address_2": "SUITE 610",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MOUNT HOPE AVE",
            "address_2": "SUITE 610",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015691",
            "telephone_number": "207-945-5952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK A. PORT, DMD & GREG S. SOLOMON, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOLOMON",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-945-5952",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10909000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.