SQUAXIN ISLAND TRIBE (SQUAXIN ISLAND DENTAL CLINIC ENCOUNTER) NPI 1003021338

Clinic/Center (Dental) in Shelton, WA

NPI 1003021338 Organization Clinic/Center Dental

About SQUAXIN ISLAND TRIBE (SQUAXIN ISLAND DENTAL CLINIC ENCOUNTER)

Squaxin Island Tribe (squaxin Island Dental Clinic Encounter) is a provider established in Shelton, Washington specializing in clinic/center (dental) . The NPI number of Squaxin Island Tribe (squaxin Island Dental Clinic Encounter) is 1003021338 and was assigned on May 2007. The practitioner's primary taxonomy code is 261QD0000X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's other name is Squaxin Island Tribe. The authorized official of this NPI record is Whitney Jones (Director)

NPI

1003021338

Provider NameSQUAXIN ISLAND TRIBE (SQUAXIN ISLAND DENTAL CLINIC ENCOUNTER)
Provider Location Address90 SE KLAH CHE MIN DR SHELTON, WA 98584
Provider Mailing Address90 SE KLAH CHE MIN DR SHELTON, WA 98584
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameSQUAXIN ISLAND TRIBE
Other Name TypeOther Name (5)
Enumeration Date05-11-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code261QD0000X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationDental
License StateWA

Business Address

SQUAXIN ISLAND TRIBE
90 SE KLAH CHE MIN DR
SHELTON, WA
ZIP 98584
Phone: (360) 427-9006

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Mailing Address

SQUAXIN ISLAND TRIBE
90 SE KLAH CHE MIN DR
SHELTON, WA
ZIP 98584
Phone: (360) 427-9006



Authorized Official

Authorized Official Name WHITNEY JONES
Authorized Official TitleDIRECTOR
Authorized Official Phone(360) 427-9006

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
5400122MEDICAID (05)WA

Other Providers at the same location


The following 14 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1669532578SQUAXIN ISLAND TRIBE
Organization
Clinic/Center90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1821113119MR. CHARLES TIFFANY BARRET P.A.-C.
Individual
Physician Assistant (Medical)90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1588782247MS. MICHELLE LOUISE WILEY RDH
Individual
Dental Hygienist90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1205007762 BRENDA DORSEY MSW, LMHC
Individual
Counselor (Mental Health)90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 432-3921
1114184579MISS SUSAN ROWSON MA
Individual
Counselor90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 432-3896
1063647923MS. PAMELA LYNN PETERS RN
Individual
Registered Nurse90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1619241882 DOUGLAS REITSCH RPH
Individual
Pharmacist90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 432-3990
1316329980 JONATHAN CORBIN WILTON M.D.
Individual
Family Medicine90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1386263820MRS. DENEICE GURRAD RPH
Individual
Pharmacist90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 432-3990
1619180981SQUAXIN ISLAND MEDICAL ENCOUNTER
Organization
Clinic/Center (Health Service)90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1255546578SQUAXIN ISLAND DENTAL CLINIC FFS
Organization
Clinic/Center (Dental)90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1912112244SQUAXIN ISLAND CHEMICAL DEPENDENCY ENCOUNTER
Organization
Clinic/Center (Rehabilitation, Substance Use Disorder)90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1114135779SQUAXIN ISLAND MEDICAID ENCOUNTER
Organization
Clinic/Center90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006
1598973158SQUAXIN ISLAND MEDICAL ENCOUNTER
Organization
Clinic/Center (Health Service)90 SE KLAH CHE MIN DR
SHELTON, WA 98584
(360) 427-9006

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.