| NPI | 1205002136 |
|---|---|
| Other Name | SISKIYOU COMMUNITY HEALTH CENTER DENTAL FACILITY |
| Entity Type | Organization |
| Authorized Contact | RICHARD BOOTH CEO 541-471-3455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 124Q00000X Dental Hygienist (Licence: OR H3448) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2021-10-06 |