Provider Demographics
NPI:1386301422
Name:SOULT & SWANSON, PLLC
Entity type:Organization
Organization Name:SOULT & SWANSON, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MCKINLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-477-8219
Mailing Address - Street 1:1444 S POTOMAC ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4516
Mailing Address - Country:US
Mailing Address - Phone:303-337-2794
Mailing Address - Fax:
Practice Address - Street 1:1444 S POTOMAC ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4516
Practice Address - Country:US
Practice Address - Phone:303-337-2794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment