Provider Demographics
NPI:1487937371
Name:SUND, SOLOMON (DMD, MPH)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:SUND
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S 19TH ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6628
Mailing Address - Country:US
Mailing Address - Phone:415-572-6217
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:402 MEDICAL ARTS BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:415-572-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626111223E0200X
PADS0387161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics