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General NPI Number Information
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NPI Number | 1992977235
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Entity Type | Organization
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Legal Business Name | DR ALI SOULATI DDS LLC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 508 CYNWOOD DR STE A
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City | EASTON
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State | MD
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Zip | 21601-3892
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Country | US
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Telephone | 410-819-0060
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Fax | 410-819-0031
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Provider Business Mailing Address
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Address Line | 508 CYNWOOD DR STE A
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City | EASTON
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State | MD
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Zip | 21601-3892
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Country | US
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Telephone | 410-819-0060
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Fax | 410-819-0031
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ALI SOULATI
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Credential | DDS
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Telephone | 410-819-0060
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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 | 13057
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License Number State | MD
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