Healthcare Provider Details

I. General information

NPI: 1922925122
Provider Name (Legal Business Name): NORTH PLAINS TENDERCARE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10395 NW GLENCOE RD STE 100
NORTH PLAINS OR
97133-8208
US

IV. Provider business mailing address

10395 NW GLENCOE RD STE 100
NORTH PLAINS OR
97133-8208
US

V. Phone/Fax

Practice location:
  • Phone: 503-647-0055
  • Fax:
Mailing address:
  • Phone: 503-647-0055
  • Fax: 503-647-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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