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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