Provider Demographics
NPI:1821363276
Name:MONROE DENTAL CARE,LLC
Entity Type:Organization
Organization Name:MONROE DENTAL CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JIA LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-305-6068
Mailing Address - Street 1:PO BOX 56255
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97238-6255
Mailing Address - Country:US
Mailing Address - Phone:503-305-6068
Mailing Address - Fax:
Practice Address - Street 1:2403 SE MONROE ST STE F
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:503-305-6068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR75391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty