Active NPI
Michael T Pitzen, DDS
- General Practice Dentistry
- University Place, WA
National Provider Identifier
1487802344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9076
- Practice address
- 4303 Bridgeport Way W
University Place, WA 98466 - Phone
- (253) 564-5545
- Fax
- (253) 564-5589
- NPI assigned
- Sep 4, 2008
- Last updated
- Jan 10, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9076 | WA | Primary |
Addresses
Primary practice location
4303 Bridgeport Way W
University Place, WA 98466
Mailing address
10927 Greengate LN SW
Lakewood, WA 98498
Phone (253) 722-6600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9076 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641772800000",
"number": "1487802344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10927 GREENGATE LN SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "98498",
"telephone_number": "253-722-6600",
"fax_number": "253-564-5589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4303 BRIDGEPORT WAY W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "98466",
"telephone_number": "253-564-5545",
"fax_number": "253-564-5589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PITZEN",
"first_name": "MICHAEL",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-04",
"last_updated": "2022-01-10",
"certification_date": "2022-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "9076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in University Place, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.