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General NPI Number Information
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NPI Number | 1699861427
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Entity Type | Organization
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Legal Business Name | STILLAGUAMISH TRIBE OF INDIANS
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 430 N WEST AVE STE 1
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City | ARLINGTON
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State | WA
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Zip | 98223-1539
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Country | US
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Telephone | 360-403-8761
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Fax | 360-474-9085
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Provider Business Mailing Address
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Address Line | 430 N WEST AVE STE 1
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City | ARLINGTON
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State | WA
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Zip | 98223-1539
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Country | US
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Telephone | 360-403-8761
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Fax | 360-474-9085
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Authorized Official
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Title or Position | DIRECTOR OF SOCIAL & HEALTH SERVICE
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Name | MR. THOMAS ASHLEY
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Credential |
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Telephone | 360-653-1104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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