Active NPI
White Swan Dental Clnic
- Dental Clinic/Center
- White Swan, WA
National Provider Identifier
1245378389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- WHITE SWAN DENTAL CLNIC
- Practice address
- 62 Bird Song Lane
White Swan, WA 98952 - Phone
- (509) 874-2028
- NPI assigned
- Feb 1, 2007
- Organization subpart
- Yes
- Parent organization
- WHITE SWAN DENTAL CLINIC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Jay Sampson
- Title
- Ceo
- Phone
- (509) 865-2102
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Primary |
Addresses
Primary practice location
62 Bird Song Lane
White Swan, WA 98952
Mailing address
PO Box 693
White Swan, WA 87841
Phone (509) 865-2102
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100506 | Medicaid | WA | |
| 21940 | Other | WA | LABOR & INDSTRY MED # |
| 51239 | Other | WA | LABOR & INDSTRY RX # |
Other names 1
- IHS Yakama Service Unit
National Provider Directory
National Provider Directory- Part of
- White Swan Dental Clnic
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1245378389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 693",
"city": "WHITE SWAN",
"state": "WA",
"postal_code": "87841",
"telephone_number": "509-865-2102",
"fax_number": "509-865-4986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 BIRD SONG LANE",
"city": "WHITE SWAN",
"state": "WA",
"postal_code": "98952",
"telephone_number": "509-874-2028"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WHITE SWAN DENTAL CLNIC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WHITE SWAN DENTAL CLINIC",
"enumeration_date": "2007-02-01",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "SAMPSON",
"authorized_official_first_name": "JAY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "509-865-2102",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100506",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDSTRY MED #",
"identifier": "21940",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDSTRY RX #",
"identifier": "51239",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "IHS Yakama Service Unit",
"code": "5",
"type": "Other Name"
}
]
}Other providers in White Swan, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.