Healthcare Provider Details

I. General information

NPI: 1700876745
Provider Name (Legal Business Name): ALAN MARK MONTROSE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 SW CEDAR HILLS BLVD SUITE 180
BEAVERTON OR
97229
US

IV. Provider business mailing address

3800 SW CEDAR HILLS BLVD SUITE 180
BEAVERTON OR
97229
US

V. Phone/Fax

Practice location:
  • Phone: 503-644-7763
  • Fax:
Mailing address:
  • Phone: 503-644-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5975
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: