| Quileute Tribal Council | |
|
560 Quileute Heights Loop La Push WA 98350 | |
| (360) 374-3358 | |
| Not Available |
| Full Name | Quileute Tribal Council |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 560 Quileute Heights Loop, La Push, Washington |
| Authorized Official Name and Position | Gary Bryan Goodwin (BILLING AGENCY) |
| Authorized Official Contact | 3608670709 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Quileute Tribal Council Po Box 189 La Push WA 98350-0189 Ph: (360) 374-3358 | Quileute Tribal Council 560 Quileute Heights Loop La Push WA 98350 Ph: (360) 374-3358 |
| NPI Number | 1518425511 |
|---|---|
| Provider Enumeration Date | 03/08/2019 |
| Last Update Date | 03/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518425511 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |