Provider Demographics
NPI:1417039843
Name:NIMKEE DENTAL SAGINAW CHIPPEWA INDIAN TRIBE
Entity Type:Organization
Organization Name:NIMKEE DENTAL SAGINAW CHIPPEWA INDIAN TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-775-4631
Mailing Address - Street 1:2591 S LEATON RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-4662
Mailing Address - Fax:989-775-4666
Practice Address - Street 1:2591 S LEATON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-4662
Practice Address - Fax:989-775-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty