Organization
FOREST GROVE KIDS' DENTIST, LLC
Active
Parent organization
TRR, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRR, LLC
Authorized official
TIMOTHY RICHARDSON DDS (OWNER)
(360) 852-0809
Entity
Organization
Contact information
Practice address
2742 19TH AVE, FOREST GROVE, OR 97116-2623
(360) 852-0809
Mailing address
2742 19TH AVE, FOREST GROVE, OR 97116-2623
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9577
OR
Other
Enumeration date
02/27/2014
Last updated
02/27/2014
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