Three Rivers Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6843 Issued in OR

Legal business name

THREE RIVERS DENTAL

Doing business as

Rainier Park Dental

Practice address

101 5TH St W
Rainier, OR 97048

Phone

(503) 556-3744

Fax

(503) 556-3134

NPI assigned

Oct 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Pham, DDSNPI 1114165966

Title

President

Phone

(360) 740-6212

Specialties & licenses 1

Addresses

Other names 1

• Rainier Park Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Pham, D.D.S.

  • Dentist
  • Chehalis, WA
  • NPI 1114165966
  NPD (past) Authorized official
• Perry Lee Fiscus, DMD

  • Dentist
  • Rainier, OR
  • NPI 1023215381
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467536318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 NW LOUISIANA AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98532",
            "telephone_number": "360-740-6212",
            "fax_number": "360-740-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 5TH ST W",
            "city": "RAINIER",
            "state": "OR",
            "postal_code": "97048",
            "telephone_number": "503-556-3744",
            "fax_number": "503-556-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-740-6212",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rainier Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelley Rothenberger, LMT
• Sara L Evans DMD PC (Northwest Family Dental)
• Christina Marie Soisson, PA-C
• Robert James Sorlien, DMD
• Brad Strong
• Ruth Trenner, DC
• Edmond Arthur Vanbellinghen, D.D.S.
• Cynthia D Vogel, LCSW
• Michele Yurgin, LPC, LMHC, NCC

• General Practice Dentistry in Rainier, OR
• Providers in Rainier, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.