# JAMESTOWN S'KLALLAM TRIBE

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

## Provider details

- **NPI number:** 1477630507
- **Authorized official:** W. RON ALLEN (TRIBAL CHAIRMAN/EXECUTIVE DIRECTOR)
- **Authorized official phone:** (360) 683-1109

## Contact information

- **Practice address:** 1033 OLD BLYN HWY, SEQUIM, WA 98382-7670
- **Practice address phone:** (360) 683-1109
- **Practice address fax:** (360) 683-3401
- **Mailing address:** 1033 OLD BLYN HWY, SEQUIM, WA 98382-7670
- **Mailing address phone:** (360) 683-1109
- **Mailing address fax:** (360) 683-3401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 261QF0400X | Federally Qualified Health Center (FQHC) | — | NULL | — |
| 261QP0904X | Federal Public Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 12/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7123433 | — | WA |