Healthcare Provider Details

I. General information

NPI: 1447530399
Provider Name (Legal Business Name): TULALIP TRIBES OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271
US

IV. Provider business mailing address

6406 MARINE DR STE A
TULALIP WA
98271
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4511
  • Fax: 360-716-5789
Mailing address:
  • Phone: 360-716-5800
  • Fax: 360-716-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00007477
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60104988
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010342
License Number StateWA

VIII. Authorized Official

Name: CHRISTOPHER KINSLOW
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 360-716-4511