Provider Demographics
NPI:1558515544
Name:ALCORN, MONIKA BRIGITTE (RDH)
Entity Type:Individual
Prefix:MS
First Name:MONIKA
Middle Name:BRIGITTE
Last Name:ALCORN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19325 SW ROSA RD
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-4452
Mailing Address - Country:US
Mailing Address - Phone:503-848-6263
Mailing Address - Fax:
Practice Address - Street 1:19325 SW ROSA RD
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-4452
Practice Address - Country:US
Practice Address - Phone:503-848-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5524124Q00000X
OR189428126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant