Provider Demographics
NPI:1093911026
Name:SOULE, SCOTT S (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:SOULE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 HAMBURG STREET
Mailing Address - Street 2:
Mailing Address - City:ROTTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12303-3764
Mailing Address - Country:US
Mailing Address - Phone:518-355-3100
Mailing Address - Fax:518-356-3115
Practice Address - Street 1:2521 HAMBURG STREET
Practice Address - Street 2:
Practice Address - City:ROTTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12303-3764
Practice Address - Country:US
Practice Address - Phone:518-355-3100
Practice Address - Fax:518-356-3115
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 0483041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice