Organization
PROVAIL DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL HATZENBELER (CEO)
(206) 826-1044
Entity
Organization
Contact information
Practice address
10215 LAKE CITY WAY NE STE E, SEATTLE, WA 98125-7758
(206) 632-2612
Mailing address
3670 STONE WAY N, SEATTLE, WA 98103-8004
(206) 363-7303
(206) 826-0181
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5716808
—
WA
Enumeration date
08/06/2007
Last updated
07/21/2022
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