Organization
SALMON CREEK ORAL & MAXILLOFACIAL SURGERY,LLC
Active
Organization
SALMON CREEK ORAL & MAXILLOFACIAL SURGERY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG W WONG DMD (OWNER/PRESIDENT)
(360) 695-2400
Entity
Organization
Contact information
Practice address
14411 NE 20TH AVE, SUITE 111, VANCOUVER, WA 98686-6431
(360) 695-2400
(360) 906-1116
Mailing address
14411 NE 20TH AVE, SUITE 111, VANCOUVER, WA 98686-6431
(360) 695-2400
(360) 906-1116
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
WA5774
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5049937
—
WA
Enumeration date
05/21/2009
Last updated
11/19/2009
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