Provider Demographics
NPI:1225418080
Name:SOUDERS, SALLY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:A
Last Name:SOUDERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:M
Other - Last Name:ALKALAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6371 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248
Mailing Address - Country:US
Mailing Address - Phone:513-746-8228
Mailing Address - Fax:513-574-7118
Practice Address - Street 1:6371 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248
Practice Address - Country:US
Practice Address - Phone:513-746-8228
Practice Address - Fax:513-574-7118
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30024493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist