Provider Demographics
NPI:1497121669
Name:SOULT, MCKINLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MCKINLEY
Middle Name:
Last Name:SOULT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 S POTOMAC ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4516
Mailing Address - Country:US
Mailing Address - Phone:303-337-2794
Mailing Address - Fax:
Practice Address - Street 1:1444 S POTOMAC ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4516
Practice Address - Country:US
Practice Address - Phone:303-337-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31383122300000X
CODEN.00204834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist