Provider Demographics
NPI:1598968398
Name:MICHAEL C SOULT DMD & ALBERT H HACKMAN III, INC.
Entity Type:Organization
Organization Name:MICHAEL C SOULT DMD & ALBERT H HACKMAN III, INC.
Other - Org Name:DENTAL REFLECTIONS - BETHEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOULT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-459-0011
Mailing Address - Street 1:974 BETHEL ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:641-459-0011
Mailing Address - Fax:614-459-0883
Practice Address - Street 1:974 BETHEL ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-459-0011
Practice Address - Fax:614-459-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0218031223G0001X
OH30-0139861223P0221X
OH30-0205831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty