Brian T Povolny, DDS MSD PHD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE00005752 Issued in WA

Practice address

411 Strander Blvd Suite 104
Tukwila, WA 98188

Phone

(206) 575-1515

Fax

(206) 575-1219

NPI assigned

Sep 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316046857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 STRANDER BLVD SUITE 104",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "98188",
            "telephone_number": "206-575-1515",
            "fax_number": "206-575-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 STRANDER BLVD SUITE 104",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "98188",
            "telephone_number": "206-575-1515",
            "fax_number": "206-575-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POVOLNY",
        "first_name": "BRIAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS MSD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE00005752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Jeanette Pluviose
• Tylar Polidori
• Camille Marie Pompeo, D.D.S.
• Sierra Poole
• Kelsey Markham Pope, APRN
• Himanshu Prakash
• Elizabeth Pratt
• Emily Paige Preboski-Michel, DMD
• Layla Prentice
• Ralph Arthur Preston Jr., BS

• Orthodontics and Dentofacial Orthopedics Dentistry in Tukwila, WA
• Providers in Tukwila, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.