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Organization
GERMAN WISE DENTAL LLC
Active
Organization
GERMAN WISE DENTAL LLC
Active
Other names
Lower Columbia Oral Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM WISE DDS, MOM, MSC, MDS. (OWNER)
(360) 636-3400
Entity
Organization
Contact information
Practice address
1538 11TH AVE, LONGVIEW, WA 98632-4123
(360) 636-3400
(360) 578-1277
Mailing address
1538 11TH AVE, LONGVIEW, WA 98632-4123
(360) 636-3400
(360) 578-1277
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QD0000X
Dental Clinic/Center
—
NULL
Other
Enumeration date
04/19/2019
Last updated
12/16/2021
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