Three Rivers Oral and Facial Surgery LLC

NPI #1164265633 in Tualatin, Oregon

Provider Information

NPI Number: 1164265633
Entity Type: Organization
Organization Name: Three Rivers Oral and Facial Surgery LLC
Primary Specialty: Oral & Maxillofacial Surgery
Enumeration Date: Jun 13, 2024
Last Updated: Jun 13, 2024

Practice Location

Address: 6464 SW BORLAND RD STE D3
City: Tualatin
State: Oregon
ZIP Code: 97062-8861
Phone: (503) 692-5654

Authorized Official

Name: DR. DANIEL PETRISOR, DMD, MD, FACS
Title: SURGEON
Phone: (503) 692-5654

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X
Oral & Maxillofacial Surgery	204E00000X	Primary

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