Soul Dental West PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUL DENTAL WEST PLLC

Practice address

853 11TH Ave
New York, NY 10019

Phone

(212) 201-0718

Fax

(646) 597-6068

NPI assigned

Feb 14, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alla Malanitcheva

Title

Administrator

Phone

(718) 916-6748

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550102400000",
    "number": "1083170021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 11TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10019",
            "telephone_number": "212-201-0718",
            "fax_number": "646-597-6068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 11TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10019",
            "telephone_number": "212-201-0718",
            "fax_number": "646-597-6068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL DENTAL WEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-14",
        "last_updated": "2019-02-14",
        "status": "A",
        "authorized_official_last_name": "MALANITCHEVA",
        "authorized_official_first_name": "ALLA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-916-6748"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "055567",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georges Maxime Souffrant
• Kimberly Terese Souffront, FNP
• Haesun Souh
• Kristen Soukup, LCSW
• Soul Dental Chelsea, P.C.
• Soul Through Mental Health Counseling PLLC
• Marisol Soula, MD/PHD
• Charles R Soule, PH.D.
• Virginia Gerhart Soules, M.D.
• Soulful Grace LCSW PLLC

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.