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General NPI Number Information
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NPI Number | 1114843653
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Entity Type | Organization
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Legal Business Name | DENTOLOGIE, PC
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 1530 MELROSE AVE
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City | SEATTLE
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State | WA
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Zip | 98122-3608
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Country | US
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Telephone | 206-586-8442
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Fax |
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Provider Business Mailing Address
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Address Line | 1259 S WABASH AVE
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City | CHICAGO
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State | IL
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Zip | 60605-2412
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Country | US
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Telephone | 312-846-6752
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, RCM
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Name | MR. KENNETH NEIL SULLIVAN
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Credential |
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Telephone | 615-707-0786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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