# PROVAIL DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487845327
- **Authorized official:** MR. MICHAEL HATZENBELER (CEO)
- **Authorized official phone:** (206) 826-1044

## Contact information

- **Practice address:** 10215 LAKE CITY WAY NE STE E, SEATTLE, WA 98125-7758
- **Practice address phone:** (206) 632-2612
- **Mailing address:** 3670 STONE WAY N, SEATTLE, WA 98103-8004
- **Mailing address phone:** (206) 363-7303
- **Mailing address fax:** (206) 826-0181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | WA | Yes |

## Other

- **Enumeration date:** 08/06/2007
- **Last updated:** 07/21/2022