Provider Demographics
NPI:1770704868
Name:CAIN, ROBERT EDFORD (LD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDFORD
Last Name:CAIN
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NE LINCOLN
Mailing Address - Street 2:SUITE B
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124
Mailing Address - Country:US
Mailing Address - Phone:503-640-2312
Mailing Address - Fax:503-648-3661
Practice Address - Street 1:232 NE LINCOLN
Practice Address - Street 2:SUITE B
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:503-640-2312
Practice Address - Fax:503-648-3661
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR941721122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
125380Medicare ID - Type Unspecified