Swinomish/Upper Skagit Dental Clinic
Organization Active NPI Public Health or Welfare Agency · La Conner, WA
NPI 1104093731 · NPPES record last updated May 13, 2008
Key facts
- NPI
- 1104093731
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- License
- NC6498 (NC)
- Legal business name
- SWINOMISH/UPPER SKAGIT DENTAL CLINIC
- Practice address
- 17395 Reservation Rd
La Conner, WA 98257-8802 - Phone
- (360) 466-3900
- NPI assigned
- May 13, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Raymond A Dailey, DDS
- Title
- Dentist
- Phone
- (360) 466-3900
Corporate family (same tax ID) 9
Practitioners 5
-
Raymond Dailey, DDS
-
Rachael R Hogan, DDS
-
Tamara M Holmes, RDH
-
Lindsey Monica Montileaux Mabbutt, DDS, MPH
-
Leah Beth Thibert, RDH
National Provider Directory
- Tax ID family
- Swishomish Indian Healt
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | NC6498 | NC | Yes |
| Point of Service | 305S00000X | NC6498 | NC |
Addresses
Primary practice location
17395 Reservation Rd
La Conner, WA 98257-8802
Mailing address
PO Box 332
La Conner, WA 98257-0332
Phone (360) 466-3900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5039490 | Medicaid | WA |
Other providers in La Conner, WA
- Swinomish Indian Tribal Community
- Swinomish Indian Tribal Community
- Swinomish Indian Tribal Community
- Swinomish Tribal Mental Health Program
- Swinomish Upper Skagit Dental
- Leah Beth Thibert
- Charles Forrest Thomas
- Robert Kenneth Wadlin
- Chad G Walker
- Laura Wall
All providers in La Conner, WA · Public Health or Welfare Agency in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.