Healthcare Provider Details

I. General information

NPI: 1821908617
Provider Name (Legal Business Name): DEMENTIA PRIMARY CARE PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 NE 297TH CT
CAMAS WA
98607-6105
US

IV. Provider business mailing address

3242 NE 3RD AVE
CAMAS WA
98607-2408
US

V. Phone/Fax

Practice location:
  • Phone: 360-609-7318
  • Fax:
Mailing address:
  • Phone: 360-609-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEREMY CHRISMAN
Title or Position: CEO
Credential: DO
Phone: 360-609-7318