NPIMap

Organization Active NPI

Port Gamble S'Klallam Dental Clinic

  • Dental Clinic/Center
  • Kingston, WA
National Provider Identifier
1669531067
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PORT GAMBLE S'KLALLAM DENTAL CLINIC
Practice address
32014 Little Boston Rd NE
Kingston, WA 98346-9734
Phone
(360) 297-9601
Fax
(360) 297-9614
NPI assigned
Dec 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kerstin Margareta Powell
Title
Health Center Business Office Manag
Phone
(360) 297-9601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

32014 Little Boston Rd NE
Kingston, WA 98346-9734

Mailing address

32014 Little Boston Rd NE
Kingston, WA 98346-9734
Phone (360) 297-9601

Other identifiers 2

IdentifierTypeStateIssuer
5031810MedicaidWA
5031794MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Port Gamble S'Klallam Dental Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669531067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32014 LITTLE BOSTON RD NE",
            "city": "KINGSTON",
            "state": "WA",
            "postal_code": "983469734",
            "telephone_number": "360-297-9601",
            "fax_number": "360-297-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32014 LITTLE BOSTON RD NE",
            "city": "KINGSTON",
            "state": "WA",
            "postal_code": "983469734",
            "telephone_number": "360-297-9601",
            "fax_number": "360-297-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT GAMBLE S'KLALLAM DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "KERSTIN",
        "authorized_official_middle_name": "MARGARETA",
        "authorized_official_title_or_position": "HEALTH CENTER BUSINESS OFFICE MANAG",
        "authorized_official_telephone_number": "360-297-9601"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5031810",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5031794",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.