Provider Demographics
NPI:1447420591
Name:WINSLOW INDIAN HEALTH CARE CTR DENTAL
Entity Type:Organization
Organization Name:WINSLOW INDIAN HEALTH CARE CTR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF DENTAL
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-289-4646
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-0400
Mailing Address - Country:US
Mailing Address - Phone:928-289-4646
Mailing Address - Fax:928-289-6291
Practice Address - Street 1:500 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2169
Practice Address - Country:US
Practice Address - Phone:928-289-4646
Practice Address - Fax:928-289-6291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINSLOW INDIAN HEALTH CARE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ758518Medicaid