Organization
PORT GAMBLE S'KLALLAM DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERSTIN MARGARETA POWELL (HEALTH CENTER BUSINESS OFFICE MANAG)
(360) 297-9601
Entity
Organization
Contact information
Practice address
32014 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
(360) 297-9601
(360) 297-9614
Mailing address
32014 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
(360) 297-9601
(360) 297-9614
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5031794
—
WA
05
—
5031810
—
WA
Enumeration date
12/08/2006
Last updated
08/22/2020
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