PROF. SAM WISE (NPI# 1417416728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417416728 |
| Entity Type | Individual |
| Full Name | PROF. SAM WISE |
| Credential | DDS, MOM, MSC, MDS |
| Practice Address |
1538 11th Ave Lowr Columbia Longview WA 98632 |
| Mailing Address |
1538 11th Ave Lowr Columbia Longview WA 98632-4123 |
| Practice Telephone | 3606363400 |
| Mailing Telephone | 3606363400 |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2019-06-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DE60795714 | WA | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
60795714 | WA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI II | 1518520170 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 3606363400 | |
| 4700 42nd Ave Sw Ste 460, Seattle, WA 981164589 | 2067674851 |
| Street Address |
1538 11TH AVE LOWR COLUMBIA |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| 1568853885 | Kaaren Lilly Marie Spanski-dreffin | Counselor | 1105 D 15th Ave, 186, Longview, WA 98632 | 2015-02-09 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952459307 | East Texas Oral & Maxillofacial Surgery Associates Inc. | Dentist | 3004 H G Moseley Pkwy, Longview, TX 75605-2948 | 2007-01-08 |
| 1518520170 | Lower Columbia Oral Health | Dentist | 1538 11th Ave, Longview, WA 98632-4123 | 2019-04-19 |
| 1760828370 | Christopher James Johnson | Dentist | 3004 H G Mosley Pkwy, Longview, TX 75605-2948 | 2013-05-22 |
| 1164454757 | Timothy E Nelson | Dentist | 855 11th Ave, Suite B, Longview, WA 98632-2461 | 2006-07-06 |
| 1801825948 | Ricney F. Newhouse | Dentist | 855 11th Ave, Suite B, Longview, WA 98632-2461 | 2006-07-01 |
| 1821027913 | Timothy E Nelson Dds Ps | Dentist | 855 11th Ave, Suite B, Longview, WA 98632-2461 | 2006-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619657 | Washington Jaw and Facial Surgery Pllc | Dentist | 451 Duvall Ave Ne Ste 100, Renton, WA 98059-4675 | 2020-11-02 |
| 1952909145 | Calley Christie Dmd Pllc | Dentist | 275 Sw 160th St Ste 115, Burien, WA 98166-3003 | 2020-10-11 |
| 1679197016 | Tae Youn Dds Md Pllc | Dentist | 15808 Mill Creek Blvd Ste 202, Mill Creek, WA 98012-1500 | 2020-06-02 |
| 1740744374 | Thompson Ferguson Schrack Pllc | Dentist | 7604 Ne 5th Ave Ste 114, Vancouver, WA 98665-8200 | 2019-01-28 |
| 1053875096 | John K Tidwell Dds and Elizabeth A Kutcipal Dds Pllc | Dentist | 1801 Nw Market St Ste 108, Seattle, WA 98107-3909 | 2019-01-23 |
| 1255803904 | Edwards, Johnson, Johnson & Johnson D.d.s., P.l.l.c. | Dentist | 601 S Carr Rd Ste 300, Renton, WA 98055-5840 | 2018-12-19 |
| 1104396969 | Mark Stivers, Dds, Inc., P.s. | Dentist | 12728 19th Ave Se Ste 101, Everett, WA 98208-6526 | 2018-12-04 |
| 1144797499 | Washington Jaw and Facial Surgery Pllc | Dentist | 1370 116th Ave Ne Ste 101, Bellevue, WA 98004-3825 | 2018-10-25 |
| 1780151027 | Washington Jaw and Facial Surgery Pllc | Dentist | 2111 N Northgate Way Ste 105, Seattle, WA 98133-9018 | 2018-10-25 |
| 1043728827 | Lance D Keyes Dds | Dentist | 32650 State Route 20 Ste E106, Oak Harbor, WA 98277 | 2018-01-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.