Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Parent organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Other names
Peter Christensen Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Authorized official
JEANNE M WOLFE BACHELORS DEGREE (COMPLIANCE OFFICER)
(715) 588-4466
Entity
Organization
Contact information
Practice address
128 OLD ABE RD, LAC DU FLAMBEAU, WI 54538-9682
(715) 588-4466
(715) 588-2269
Mailing address
128 OLD ABE ROAD, LAC DU FLAMBEAU, WI 54538-9682
(715) 588-4466
(715) 588-2269
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Enumeration date
03/31/2011
Last updated
01/28/2014
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