Healthcare Provider Details

I. General information

NPI: 1164342903
Provider Name (Legal Business Name): HANNAH CERAVOLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC OAK HARBOR 3475 N SARATOGA STREET BUILDING 993
OAK HARBOR WA
98278-8800
US

IV. Provider business mailing address

259 SE ELY ST UNIT A1
OAK HARBOR WA
98277-5225
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: