Organization
CONFEDERATED TRIBES OF COOS, LOWER UMPQUA, & SIUSLAW INDIANS
Active
Other names
Three Rivers Health Center - Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R REEVES III MHA (HEALTH ADMINISTRATOR)
(808) 214-7269
Entity
Organization
Contact information
Practice address
1245 FULTON AVE, COOS BAY, OR 97420-2895
(541) 888-6433
Mailing address
1245 FULTON AVE, COOS BAY, OR 97420-2895
(541) 888-6433
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
—
—
125J00000X
Dental Therapist
—
—
207Q00000X
Family Medicine Physician
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165383
—
OR
Enumeration date
06/05/2024
Last updated
06/05/2024
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