Active NPI
Mark A. Hablitzel, D.D.S.
- General Practice Dentistry
- Port Clinton, OH
National Provider Identifier
1982910733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13885
- Practice address
- 304 Madison St
Port Clinton, OH 43452-1937 - Phone
- (419) 734-2175
- NPI assigned
- Aug 30, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13885 | OH | Primary |
Addresses
Primary practice location
304 Madison St
Port Clinton, OH 43452-1937
Mailing address
304 Madison St
Port Clinton, OH 43452-1937
Phone (419) 734-2175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0405056 | Medicaid | OH |
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 |
|---|---|---|---|
| 13885 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283212800000",
"number": "1982910733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 MADISON ST",
"city": "PORT CLINTON",
"state": "OH",
"postal_code": "434521937",
"telephone_number": "419-734-2175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 MADISON ST",
"city": "PORT CLINTON",
"state": "OH",
"postal_code": "434521937",
"telephone_number": "419-734-2175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HABLITZEL",
"first_name": "MARK",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-30",
"last_updated": "2010-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "13885",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0405056",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Clinton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.