Organization
KENAITZE INDIAN TRIBE
Active
Parent organization
KENAITZE INDIAN TRIBE
Other names
Denaina Wellness Center, Denaina Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENAITZE INDIAN TRIBE
Authorized official
GREG BURNETT (FINANCE DIRECTOR)
(907) 335-7200
Entity
Organization
Contact information
Practice address
508 UPLAND ST, KENAI, AK 99611-8026
(907) 335-7500
(907) 335-2155
Mailing address
PO BOX 988, KENAI, AK 99611-0988
(907) 335-7500
(907) 335-2155
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
IHS
AK
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021855
FQHC CERTIFICATION NUMBER
AK
05
—
DDG020
—
AK
Enumeration date
01/07/2009
Last updated
12/02/2024
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