Healthcare Provider Details

I. General information

NPI: 1922924323
Provider Name (Legal Business Name): BANKS TENDERCARE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12350 NW MAIN ST STE 104
BANKS OR
97106-9045
US

IV. Provider business mailing address

12350 NW MAIN ST STE 104
BANKS OR
97106-9045
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-3409
  • Fax:
Mailing address:
  • Phone: 503-747-3409
  • Fax: 503-352-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN MAROSTICA
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 503-858-0741