Provider Demographics
NPI:1326545492
Name:SOHAIL, BETHANN (OMT)
Entity Type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:SOHAIL
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72732
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007-2732
Mailing Address - Country:US
Mailing Address - Phone:770-899-5244
Mailing Address - Fax:
Practice Address - Street 1:1744 ROSWELL RD STE 220
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3979
Practice Address - Country:US
Practice Address - Phone:770-899-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH009907124Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist