Organization
THREE RIVERS DENTAL
Active
Other names
Rainier Park Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PHAM DDS (PRESIDENT)
(360) 740-6212
Entity
Organization
Contact information
Practice address
101 5TH ST W, RAINIER, OR 97048
(503) 556-3744
(503) 556-3134
Mailing address
1515 NW LOUISIANA AVE, CHEHALIS, WA 98532
(360) 740-6212
(360) 740-6222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6843
OR
Other
Enumeration date
10/25/2006
Last updated
08/22/2020
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