SOUTH SOUND AMBULATORY SURGERY CENTER, PLLC (NPI# 1487183000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487183000 |
| Entity Type | Organization |
| Organization Name | SOUTH SOUND AMBULATORY SURGERY CENTER, PLLC |
| Practice Address |
3425 Ensign Rd Ne Ste 310 Olympia WA 98506-5063 |
| Practice Telephone | (360) 456-5678 |
| Practice Fax Number | 3604561238 |
| Mailing Telephone | 3604565678 |
| Mailing Fax Number | 3604561238 |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2017-06-07 |
| Authorized Official Name | JOSEPH C MULREAN (CO-OWNER) |
| Authorized Official Telephone | 3604565678 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTH SOUND ORAL SURGERY PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
Ambulatory Health Care Facilities | ||
| Y | 204E00000X | Oral & Maxillofacial Surgery | 601803289 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
3425 ENSIGN RD NE STE 310 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
| Find all providers in zip 98506 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033214861 | Charles R Weber | Oral & Maxillofacial Surgery | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506 | 2006-09-14 |
| 1336250133 | Joseph C Mulrean | Oral & Maxillofacial Surgery | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770112575 | Charles David Smith | Oral & Maxillofacial Surgery | 1959 Ne Pacific Street; Hsb Room B 241, Seattle, WA 98195-0001 | 2020-04-03 |
| 1366079972 | Aaron Hui | Oral & Maxillofacial Surgery | 6222 Ne 74th Street Building 25, 2nd Floor, Seattle, WA 98115 | 2020-03-24 |
| 1275093973 | Elizabeth Grace Knoff Floodeen | Oral & Maxillofacial Surgery | University of Washington Department of Surgery, 1959 Ne Pacific Street, Seattle, WA 98195 | 2019-03-20 |
| 1952840274 | Onyinyechi Kelechukwu Esonu | Oral & Maxillofacial Surgery | 1959 Ne Pacific St # 357134, University of Washington Department of Oral Surgery, Seattle, WA 98195-0001 | 2017-02-20 |
| 1861855710 | Kevin Huang | Oral & Maxillofacial Surgery | 119 S 295th Pl, Federal Way, WA 98003-3659 | 2016-03-29 |
| 1598146730 | Chia-lin Michael Tsai | Oral & Maxillofacial Surgery | 1959 Ne Pacific Street Hsb Rm B241, Box 357134, Seattle, WA 98195-0001 | 2015-06-12 |
| 1386037570 | Rodney Nakano Nishimoto | Oral & Maxillofacial Surgery | University of Washington Oms, 1959 Ne Pacific Street Box 357134, Seattle, WA 98195 | 2015-03-11 |
| 1164815569 | Joseph Garcia | Oral & Maxillofacial Surgery | 2960 Eastlake Ave E Apt 208, Seattle, WA 98102-2003 | 2015-03-09 |
| 1154687770 | Joshua Stephen Brandner | Oral & Maxillofacial Surgery | 1959 Ne Pacific Street Box 357134, Seattle, WA 98195-3372 | 2012-04-09 |
| 1538398524 | J. Michael Edwards | Oral & Maxillofacial Surgery | 265 Carefree Way, Friday Harbor, WA 98250-9417 | 2009-07-10 |
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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.