Organization
WHITE SWAN DENTAL CLNIC
Active
Parent organization
WHITE SWAN DENTAL CLINIC
Other names
IHS Yakama Service Unit
Organization subpart
Yes
Provider details
NPI number
Legal business name
WHITE SWAN DENTAL CLINIC
Authorized official
MS. JAY SAMPSON (CEO)
(509) 865-2102
Entity
Organization
Contact information
Practice address
62 BIRD SONG LANE, WHITE SWAN, WA 98952
(509) 874-2028
Mailing address
PO BOX 693, WHITE SWAN, WA 87841
(509) 865-2102
(509) 865-4986
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21940
LABOR & INDSTRY MED #
WA
01
—
51239
LABOR & INDSTRY RX #
WA
05
—
7100506
—
WA
Enumeration date
02/01/2007
Last updated
03/07/2023
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