Provider Demographics
NPI:1023475118
Name:KAW NATION
Entity type:Organization
Organization Name:KAW NATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:KAW NATION CHAIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-269-2552
Mailing Address - Street 1:3151 E. RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647
Mailing Address - Country:US
Mailing Address - Phone:580-362-1944
Mailing Address - Fax:580-362-2988
Practice Address - Street 1:3151 E. RIVER RD
Practice Address - Street 2:
Practice Address - City:NEWKIRK
Practice Address - State:OK
Practice Address - Zip Code:74647
Practice Address - Country:US
Practice Address - Phone:580-362-1944
Practice Address - Fax:580-362-2988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAW NATION DBA KANZA DENTAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental