Organization
KALISPEL TRIBE OF INDIANS
Active
Other names
Camas Center Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LYNN BIRDTAIL (AM)
(509) 447-7112
Entity
Organization
Contact information
Practice address
1821 LECLERC RD N STE 1, CUSICK, WA 99119-5015
(509) 447-7111
(509) 445-1152
Mailing address
PO BOX 67, USK, WA 99180-0067
(509) 447-7111
(509) 445-1152
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00009801
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5051537
—
WA
Enumeration date
03/24/2012
Last updated
09/13/2023
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