# SOUTH SOUND ORAL SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407944614
- **Authorized official:** MRS. LAURA JEAN CASWELL (OFFICE MANAGER)
- **Authorized official phone:** (360) 736-0715

## Contact information

- **Practice address:** 3425 ENSIGN RD NE, SUITE 310, OLYMPIA, WA 98506
- **Practice address phone:** (360) 456-5678
- **Practice address fax:** (356) 045-6123
- **Mailing address:** 3425 ENSIGN RD NE, STE 310, OLYMPIA, WA 98506
- **Mailing address phone:** (360) 456-5678
- **Mailing address fax:** (360) 456-1238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 08/22/2020