Provail Dental Clinic

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PROVAIL DENTAL CLINIC

Practice address

10215 Lake City Way NE Ste E
Seattle, WA 98125-7758

Phone

(206) 632-2612

NPI assigned

Aug 6, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Michael Hatzenbeler

Title

Ceo

Phone

(206) 826-1044

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Provail Dental Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Provail

  • Speech-Language Pathologist
  • Seattle, WA
  • NPI 1477760197
  NPD tax ID
• Provail

  • Rehabilitation Clinic/Center
  • Seattle, WA
  • NPI 1871857946
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Robert Fitzgerald, DDS

  • Dentist
  • Seattle, WA
  • NPI 1811215585
  NPD (past)

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1487845327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 STONE WAY N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981038004",
            "telephone_number": "206-363-7303",
            "fax_number": "206-826-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 LAKE CITY WAY NE STE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981257758",
            "telephone_number": "206-632-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVAIL DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HATZENBELER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-826-1044",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5716808",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janet Jeanne Proulx, LMHC, MA
• Michelle A Proulx, PH.D.
• Anne M Prouty, PHD
• Provail
• Provail
• Ashley Provance, PTA
• Fredric P. Provenzano, PH.D.
• Providence
• Providence Audiology
• Providence Health & Services - Washington

• Dental Clinic/Center in Seattle, WA
• Providers in Seattle, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.