| Lower Columbia Oral Health | |
|
1538 11th Ave Longview WA 98632-4123 | |
| (360) 636-3400 | |
| (360) 578-1277 |
| Full Name | Lower Columbia Oral Health |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1538 11th Ave, Longview, Washington |
| Authorized Official Name and Position | Sam Wise (OWNER) |
| Authorized Official Contact | 3606363400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lower Columbia Oral Health 1538 11th Ave Longview WA 98632-4123 Ph: (360) 636-3400 | Lower Columbia Oral Health 1538 11th Ave Longview WA 98632-4123 Ph: (360) 636-3400 |
| NPI Number | 1518520170 |
|---|---|
| Provider Enumeration Date | 04/19/2019 |
| Last Update Date | 12/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518520170 | NPI | - | NPPES |
| 1417416728 | Other | WA | DENTAL |
| DE60795714 | Other | WA | DENTAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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