# SQUAXIN ISLAND DENTAL CLINIC FFS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Squaxin Island Tribe
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255546578
- **Authorized official:** WHITNEY JONES (DIRECTOR)
- **Authorized official phone:** (360) 427-9006

## Contact information

- **Practice address:** 90 SE KLAH CHE MIN DR, SHELTON, WA 98584-9216
- **Practice address phone:** (360) 427-9006
- **Mailing address:** 90 SE KLAH CHE MIN DR, SHELTON, WA 98584-9216
- **Mailing address phone:** (360) 427-9006

## Taxonomy

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

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 08/22/2020