# GERMAN WISE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lower Columbia Oral Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518520170
- **Authorized official:** DR. SAM WISE DDS, MOM, MSC, MDS. (OWNER)
- **Authorized official phone:** (360) 636-3400

## Contact information

- **Practice address:** 1538 11TH AVE, LONGVIEW, WA 98632-4123
- **Practice address phone:** (360) 636-3400
- **Practice address fax:** (360) 578-1277
- **Mailing address:** 1538 11TH AVE, LONGVIEW, WA 98632-4123
- **Mailing address phone:** (360) 636-3400
- **Mailing address fax:** (360) 578-1277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/19/2019
- **Last updated:** 12/16/2021