Provider Demographics
NPI:1912241290
Name:SOULSBY, BETSEY E (RDH)
Entity Type:Individual
Prefix:
First Name:BETSEY
Middle Name:E
Last Name:SOULSBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 BERKMAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1456
Mailing Address - Country:US
Mailing Address - Phone:434-973-4355
Mailing Address - Fax:434-973-8079
Practice Address - Street 1:3025 BERKMAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1456
Practice Address - Country:US
Practice Address - Phone:434-973-4355
Practice Address - Fax:434-973-8079
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402202361124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist