Salmon Creek Oral & Maxillofacial Surgery,LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

WA5774 Issued in WA

Legal business name

SALMON CREEK ORAL & MAXILLOFACIAL SURGERY,LLC

Practice address

14411 NE 20TH Ave
Suite 111
Vancouver, WA 98686-6431

Phone

(360) 695-2400

Fax

(360) 906-1116

NPI assigned

May 21, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Craig W Wong, DMD

Title

Owner/President

Phone

(360) 695-2400

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258588800000",
    "number": "1083849913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14411 NE 20TH AVE",
            "address_2": "SUITE 111",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866431",
            "telephone_number": "360-695-2400",
            "fax_number": "360-906-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14411 NE 20TH AVE",
            "address_2": "SUITE 111",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866431",
            "telephone_number": "360-695-2400",
            "fax_number": "360-906-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALMON CREEK ORAL & MAXILLOFACIAL SURGERY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-21",
        "last_updated": "2009-11-19",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "360-695-2400",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "WA5774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5049937",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Salmon Creek Chiropractic, LLC
• Salmon Creek Dental PLLC
• Salmon Creek Family Dental
• Salmon Creek Family Practice
• Salmon Creek Family Practice PC
• Salmon Creek Oral Surgery & Periodontics
• Salmon Creek Physical Therapy P S
• Salmon Creek Plastic Surgery PC
• Salmon Creek Plastic Surgery PC
• Salmon Creek SNF Operations LLC

• Oral and Maxillofacial Surgery (Dentist) in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.