Healthcare Provider Details

I. General information

NPI: 1477811057
Provider Name (Legal Business Name): SAC & FOX TRIBE OF THE MISS IN IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 305TH ST
TAMA IA
52339-9698
US

IV. Provider business mailing address

1646 305TH ST
TAMA IA
52339-9698
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-4094
  • Fax: 461-484-2432
Mailing address:
  • Phone: 641-484-4094
  • Fax: 461-484-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. RUDY PAPAKEE PAPAKEE
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 641-484-4094