Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30-013086 | OH |
NPI | 1023106184 |
---|---|
Provider Name | Dr. Michael C Soult |
First Address | Columbus, OH 43214-2467 |
Second Address | Columbus, OH 43214-2467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0211783 | (05) | OH |