NPIMap

Organization Active NPI

Tulalip Tribes of Washington

  • Dentist
  • Tulalip, WA
National Provider Identifier
1447530399
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00010342 Issued in WA
Legal business name
TULALIP TRIBES OF WASHINGTON
Practice address
7520 Totem Beach Rd
Tulalip, WA 98271
Phone
(360) 716-4511
Fax
(360) 716-5789
NPI assigned
Aug 24, 2011
Organization subpart
Yes
Parent organization
TULALIP TRIBES OF WAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Kinslow, DDS
Title
Dental Director
Phone
(360) 716-4511

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DE00010342 WA Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DE00007477 WA
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DE60104988 WA

Addresses

Primary practice location

7520 Totem Beach Rd
Tulalip, WA 98271

Mailing address

6406 Marine Dr Ste a
Tulalip, WA 98271
Phone (360) 716-5800

Other identifiers 1

IdentifierTypeStateIssuer
2014972MedicaidWA

Other names 1

  • Tulalip Tribes Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tulalip Health Clinic13 organizations share this tax ID, including this one
Part of
Tulalip Health Clinic

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1447530399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6406 MARINE DR STE A",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "98271",
            "telephone_number": "360-716-5800",
            "fax_number": "360-716-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7520 TOTEM BEACH RD",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "98271",
            "telephone_number": "360-716-4511",
            "fax_number": "360-716-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULALIP TRIBES OF WASHINGTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TULALIP TRIBES OF WA",
        "enumeration_date": "2011-08-24",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "KINSLOW",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DENTAL DIRECTOR",
        "authorized_official_telephone_number": "360-716-4511",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010342",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00007477",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60104988",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2014972",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tulalip Tribes Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulalip, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.