# KALISPEL TRIBE OF INDIANS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Camas Center Dental Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083980080
- **Authorized official:** TRACY LYNN BIRDTAIL (AM)
- **Authorized official phone:** (509) 447-7112

## Contact information

- **Practice address:** 1821 LECLERC RD N STE 1, CUSICK, WA 99119-5015
- **Practice address phone:** (509) 447-7111
- **Practice address fax:** (509) 445-1152
- **Mailing address:** PO BOX 67, USK, WA 99180-0067
- **Mailing address phone:** (509) 447-7111
- **Mailing address fax:** (509) 445-1152

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE00009801 | WA | Yes |

## Other

- **Enumeration date:** 03/24/2012
- **Last updated:** 09/13/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5051537 | — | WA |