# SHOALWATER BAY INDIAN TRIBE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shoalwater Bay Tribal Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003028952
- **Authorized official:** MS. CAROL JOHNSON (TRIBAL ADMINISTRATOR)
- **Authorized official phone:** (360) 267-6766

## Contact information

- **Practice address:** 2373 OLD TOKELAND RD, TOKELAND, WA 98590
- **Practice address phone:** (360) 267-8103
- **Practice address fax:** (360) 267-1437
- **Mailing address:** PO BOX 500, TOKELAND, WA 98590-0500
- **Mailing address phone:** (360) 267-0119
- **Mailing address fax:** (360) 267-0417

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 08/22/2020