Provail Dental Clinic

LBN: Provail Dental Clinic
Provail Dental Clinic is an health care organization with primary practice located at 10215 Lake City Way Ne Ste E , Seattle WA 98125-7758. The organization recently has only one registered license in Ambulatory Health Care Facilities / Dental, which is considered as the primary health care specialty. Provail Dental Clinic can be contacted via phone (206) 632-2612, or through Hatzenbeler, Michael via phone (206) 826-1044.

Contact Information

Primary practice address
10215 Lake City Way Ne Ste E Seattle WA 98125-7758
Phone: (206) 632-2612
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Hatzenbeler, Michael
Phone: (206) 826-1044

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Dental 261QD0000X Washington

Profile Details

NPI number 1487845327
LBN Legal business name Provail Dental Clinic
DBA Doing business as
Authorized official Hatzenbeler, Michael
Entity Organization
Organization subpart 1 No
Enumeration date Aug 6th, 2007
Last updated Jul 21st, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487845327 NPPES
Washington MEDICAID 5716808

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