Healthcare Provider Details

I. General information

NPI: 1770704868
Provider Name (Legal Business Name): ROBERT EDFORD CAIN LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 NE LINCOLN SUITE B
HILLSBORO OR
97124
US

IV. Provider business mailing address

232 NE LINCOLN SUITE B
HILLSBORO OR
97124
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-2312
  • Fax: 503-648-3661
Mailing address:
  • Phone: 503-640-2312
  • Fax: 503-648-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number941721
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: