Provider Demographics
NPI:1700876745
Name:MONTROSE, ALAN MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARK
Last Name:MONTROSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW CEDAR HILLS BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:503-644-7763
Mailing Address - Fax:
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97229
Practice Address - Country:US
Practice Address - Phone:503-644-7763
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice