SQUAXIN ISLAND DENTAL CLINIC FFS (NPI# 1255546578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255546578 |
| Entity Type | Organization |
| Organization Name | SQUAXIN ISLAND DENTAL CLINIC FFS |
| Other Organization Name | SQUAXIN ISLAND TRIBE |
| Practice Address |
90 Se Klah Che Min Dr Shelton WA 98584-9216 |
| Practice Telephone | 3604279006 |
| Mailing Telephone | 3604279006 |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WHITNEY JONES (DIRECTOR) |
| Authorized Official Telephone | 3604279006 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 5052139 | 05 |
| Other Name | Type Code |
|---|---|
| Squaxin Island Tribe | Other Name - Individual/Organization |
| Street Address |
90 SE KLAH CHE MIN DR |
| City | SHELTON |
| State | WA |
| Zip Code | 98584-9216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669532578 | Squaxin Island Tribe | Clinic/Center | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2006-12-11 |
| 1386263820 | Deneice Gurrad | Pharmacist | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2020-04-14 |
| 1316329980 | Jonathan Corbin Wilton | Family Medicine | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2015-06-19 |
| 1619241882 | Douglas Reitsch | Pharmacist | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2012-03-05 |
| 1063647923 | Pamela Lynn Peters | Registered Nurse | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2009-05-21 |
| 1114184579 | Susan Rowson | Counselor | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2008-05-21 |
| 1205007762 | Brenda Dorsey | Counselor | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2008-03-12 |
| 1114135779 | Squaxin Island Medicaid Encounter | Clinic/Center | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2007-05-18 |
| 1598973158 | Squaxin Island Medical Encounter | Clinic/Center | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2007-05-18 |
| 1003021338 | Squaxin Island Dental Clinic Encounter | Clinic/Center | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2007-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023627478 | Ashley Maria Elena Armstrong | Counselor | 307 W Cota St Shelton, Shelton, WA 98584 | 2020-07-30 |
| 1962011015 | Perry Philemon Little IIi | Dentist | 503 N 4th St, Shelton, WA 98584 | 2020-07-24 |
| 1588215271 | Rebecca Lynn Adams | Counselor | 601 West Franklin St, Shelton, WA 98584 | 2019-09-24 |
| 1366939670 | Robbie Chandler | Social Worker | 807 West Pine, Shelton, WA 98584 | 2018-04-23 |
| 1831603075 | Fir Lane Health-shelton,llc | Skilled Nursing Facility | 2430 North 13th St, Shelton, WA 98584 | 2017-11-27 |
| 1306361738 | Christine Lee Woods | Counselor | 58150 E. 66th Road, Miami, OK 98584 | 2017-08-07 |
| 1174063051 | Claudette V. Selkridge | Counselor | 1620 N. Olympic Hwy, Shelton, WA 98584 | 2017-02-27 |
| 1003278755 | Edward Charles Herman | Social Worker | 50 Se Bluff Loop Rd., Shelton, WA 98584 | 2016-03-22 |
| 1023497310 | Darren Cuevas | Family Medicine | 939 Mountain View Dr Ste 100, Shelton, WA 98584 | 2015-05-20 |
| 1639572977 | Thomas Vincent Phung Duffy | Dentist | 717 W. Railroad Ave., Shelton, WA 98584 | 2014-10-01 |
| Find all providers in zip 98584 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891934550 | Hackney Family Dentistry | Clinic/Center | 1051 Se State Route 3, Shelton, WA 98584-7117 | 2009-02-19 |
| 1003021338 | Squaxin Island Dental Clinic Encounter | Clinic/Center | 90 Se Klah Che Min Dr, Shelton, WA 98584-9216 | 2007-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700671 | K.lee, Dds, Pllc. | Clinic/Center | 20709 Mountain Hwy E # 102, Spanaway, WA 98387-8580 | 2020-11-06 |
| 1346841376 | Ralf F. Schuler, Dr. Med. Dent., Msd,pllc | Clinic/Center | 205 W Fairhaven Ave Ste C, Burlington, WA 98233-1062 | 2020-11-05 |
| 1356942684 | Healthy Smiles Northwest | Clinic/Center | 11808 18th St Se, Lake Stevens, WA 98258-2046 | 2020-11-03 |
| 1306446240 | Christine A Woodward, Dds, Pllc | Clinic/Center | 45860 Main St, Concrete, WA 98237 | 2020-10-29 |
| 1215535695 | Ellingsen Henneberg Pllc | Clinic/Center | 2607 S Southeast Blvd Ste B210, Spokane, WA 99223-7614 | 2020-10-16 |
| 1174121792 | Evolve Dental LLC | Clinic/Center | 4410 194th St Sw Ste A, Lynnwood, WA 98036-5598 | 2020-10-15 |
| 1326646035 | Natasha Habib Dds Ps | Clinic/Center | 1025 153rd St Se Ste 103, Mill Creek, WA 98012-4051 | 2020-10-14 |
| 1386241636 | Mellissa Ilgen, Dds, Pllc | Clinic/Center | 26114 Illinois Ave Ne, Kingston, WA 98346-7674 | 2020-10-08 |
| 1417554932 | Young, Yeung, Lee, Hockin, P.s | Clinic/Center | 2207 2nd Ave, Seattle, WA 98121-2016 | 2020-10-07 |
| 1164039731 | Consolidated Dental Three | Clinic/Center | 19221 108th Ave Se Ste 2, Renton, WA 98055-7369 | 2020-09-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.