=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922924323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANKS TENDERCARE DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11960 SW PACIFIC HWY
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-6439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-670-7088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12350 NW MAIN ST STE 104
-----------------------------------------------------
City | BANKS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97106-9045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-747-3409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | JUSTIN MAROSTICA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 503-858-0741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------