Healthcare Provider Details

I. General information

NPI: 1457506081
Provider Name (Legal Business Name): SKOKOMISH TRIBAL COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-9748
US

IV. Provider business mailing address

100 N TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-9748
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-5755
  • Fax: 360-877-2032
Mailing address:
  • Phone: 360-426-5755
  • Fax: 360-877-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCES LONGSHORE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 360-426-5755