Organization
THREE RIVERS ORAL AND FACIAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL PETRISOR DMD, MD, FACS (SURGEON)
(503) 692-5654
Entity
Organization
Contact information
Practice address
6464 SW BORLAND RD STE D3, TUALATIN, OR 97062-8861
(503) 692-5654
Mailing address
6464 SW BORLAND RD STE D3, TUALATIN, OR 97062-8861
(503) 692-5654
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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