Active NPI
Haley Dietz
- Dentist
- Battle Ground, WA
National Provider Identifier
1841923281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61314756
- Practice address
- 1401 NW 1St St # 120
Battle Ground, WA 98604-4540 - Phone
- (360) 666-5700
- NPI assigned
- Jul 4, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 61314756 | WA | Primary |
Addresses
Primary practice location
1401 NW 1St St # 120
Battle Ground, WA 98604-4540
Mailing address
638 NE 79TH Ave
Portland, OR 97213-6913
Phone (540) 392-1820
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 |
|---|---|---|---|
| 61314756 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656892800000",
"number": "1841923281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "638 NE 79TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972136913",
"telephone_number": "540-392-1820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 NW 1ST ST # 120",
"city": "BATTLE GROUND",
"state": "WA",
"postal_code": "986044540",
"telephone_number": "360-666-5700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "HALEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-04",
"last_updated": "2022-07-04",
"certification_date": "2022-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "61314756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Battle Ground, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 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.