Mitchell T Harbolt, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D11664 Issued in OR

Practice address

365 Warner Milne Rd
Oregon City, OR 97045-4073

Phone

(971) 206-7115

NPI assigned

Aug 6, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1659744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1194452375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 WARNER MILNE RD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454073",
            "telephone_number": "971-206-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 WARNER MILNE RD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454073",
            "telephone_number": "971-206-7115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Main Ave",
            "address_purpose": "LOCATION",
            "city": "Tillamook",
            "state": "OR",
            "postal_code": "971413818",
            "country_code": "US",
            "telephone_number": "503-673-2676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARBOLT",
        "first_name": "MITCHELL",
        "middle_name": "T",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-06",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Elizabeth Hancock, CTRS
• Kenneth A Hand, LPC-ASSOCIATE, CADCI
• Dawn L Hanson, RN
• Lauren Hanson
• Shane R Hanzlik, M.D.
• Timothy Ray Harbolt, D.M.D
• Hardcore Happy LLC
• Linda L Hardman
• Shannon Hardman
• Audra Lee Harley

• Dentist in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.