Provider Demographics
NPI:1326581703
Name:SOULIERE, LINDA LAURETTE (LD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LAURETTE
Last Name:SOULIERE
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MOODY POND RD
Mailing Address - Street 2:
Mailing Address - City:CENTER OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03814-6716
Mailing Address - Country:US
Mailing Address - Phone:207-604-0525
Mailing Address - Fax:
Practice Address - Street 1:202 MAPLE ST UNIT C
Practice Address - Street 2:
Practice Address - City:CORNISH
Practice Address - State:ME
Practice Address - Zip Code:04020-3138
Practice Address - Country:US
Practice Address - Phone:207-625-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDTR5531122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist