# SOUTH SOUND AMBULATORY SURGERY CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTH SOUND ORAL SURGERY PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1487183000
- **Legal business name:** SOUTH SOUND ORAL SURGERY PLLC
- **Authorized official:** JOSEPH C MULREAN DMD (CO-OWNER)
- **Authorized official phone:** (360) 456-5678

## Contact information

- **Practice address:** 3425 ENSIGN RD NE STE 310, OLYMPIA, WA 98506-5063
- **Practice address phone:** (360) 456-5678
- **Practice address fax:** (360) 456-1238
- **Mailing address:** 3425 ENSIGN RD NE STE 310, OLYMPIA, WA 98506-5063
- **Mailing address phone:** (360) 456-5678
- **Mailing address fax:** (360) 456-1238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 601803289 | WA | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/07/2017
- **Last updated:** 07/21/2022