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General NPI Number Information
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NPI Number | 1639699010
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Entity Type | Individual
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Provider Name | ELISE CHANTEL SOULLIERE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 2837 STABLE DR
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City | KIMBALL
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State | MI
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Zip | 48074-1441
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Country | US
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Telephone | 810-985-3301
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 COURT ST
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City | PORT HURON
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State | MI
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Zip | 48060-4938
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Country | US
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Telephone | 810-841-8966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901022358
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License Number State | MI
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