Healthcare Provider Details

I. General information

NPI: 1114843653
Provider Name (Legal Business Name): DENTOLOGIE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MELROSE AVE
SEATTLE WA
98122-3608
US

IV. Provider business mailing address

1259 S WABASH AVE
CHICAGO IL
60605-2412
US

V. Phone/Fax

Practice location:
  • Phone: 206-586-8442
  • Fax:
Mailing address:
  • Phone: 312-846-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH NEIL SULLIVAN
Title or Position: DIRECTOR, RCM
Credential:
Phone: 615-707-0786