Healthcare Provider Details

I. General information

NPI: 1093911026
Provider Name (Legal Business Name): SCOTT S SOULE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 HAMBURG STREET
ROTTERDAM NY
12303-3764
US

IV. Provider business mailing address

2521 HAMBURG STREET
ROTTERDAM NY
12303-3764
US

V. Phone/Fax

Practice location:
  • Phone: 518-355-3100
  • Fax: 518-356-3115
Mailing address:
  • Phone: 518-355-3100
  • Fax: 518-356-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberNY 048304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: