Provider Demographics
NPI:1477811057
Name:SAC & FOX TRIBE OF THE MISS IN IOWA
Entity Type:Organization
Organization Name:SAC & FOX TRIBE OF THE MISS IN IOWA
Other - Org Name:MESKWAKI DENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:PAPAKEE
Authorized Official - Last Name:PAPAKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-484-4094
Mailing Address - Street 1:1646 305TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-9698
Mailing Address - Country:US
Mailing Address - Phone:641-484-4094
Mailing Address - Fax:461-484-2432
Practice Address - Street 1:1646 305TH ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9698
Practice Address - Country:US
Practice Address - Phone:641-484-4094
Practice Address - Fax:461-484-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty