Organization
BAY MILLS INDIAN COMMUNITY
Active
Organization
BAY MILLS INDIAN COMMUNITY
Active
Other names
Mitigoons Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY BREAKIE (HHS DIRCTOR)
(906) 248-8315
Entity
Organization
Contact information
Practice address
204 E PORTAGE AVE, SAULT SAINTE MARIE, MI 49783-2054
(906) 248-5527
(906) 248-5765
Mailing address
12455 W LAKESHORE DR, BRIMLEY, MI 49715-9327
(906) 248-5527
(906) 248-5765
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/26/2006
Last updated
06/20/2023
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