Healthcare Provider Details

I. General information

NPI: 1558046920
Provider Name (Legal Business Name): ELIZABETH MARIE SOULAS DMD, MSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N LIME ST
LANCASTER PA
17602-2748
US

IV. Provider business mailing address

223 N LIME ST
LANCASTER PA
17602-2748
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-3793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02970500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS044067
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044067
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: