Lac Du Flambeau Band of Lake Superior Chippewa Indians
NPI #1427347426 in Lac Du Flambeau, Wisconsin
Provider Information
- NPI Number
- 1427347426
- Entity Type
- Organization
- Organization Name
- Lac Du Flambeau Band of Lake Superior Chippewa Indians
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Mar 31, 2011
- Last Updated
- Jan 28, 2014
Practice Location
- Address
- 128 OLD ABE RD
- City
- Lac Du Flambeau
- State
- Wisconsin
- ZIP Code
- 54538-9682
- Phone
- (715) 588-4466
Authorized Official
- Name
- JEANNE M WOLFE, BACHELORS DEGREE
- Title
- COMPLIANCE OFFICER
- Phone
- (715) 588-4466
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
| Clinic/Center - Dental — Dental |
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