Monroe Ave Dental Care

Primary specialty

DentistTaxonomy code 122300000X

License

6102 Issued in OR

Legal business name

MONROE AVE DENTAL CARE

Practice address

853 NW Monroe Ave
Corvallis, OR 97330-6352

Phone

(541) 754-1550

Fax

(541) 754-0558

NPI assigned

Feb 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Janet Pennington Peterson

Title

Dentist/Owner

Phone

(541) 754-1550

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1790082592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 NW MONROE AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306352",
            "telephone_number": "541-754-1550",
            "fax_number": "541-754-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 NW MONROE AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306352",
            "telephone_number": "541-754-1550",
            "fax_number": "541-754-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE AVE DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "PENNINGTON",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "541-754-1550",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "6102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193607",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mojo Physical Therapy LLC
• Shawn Moling, MA
• John J Molitor Jr., MD
• Gabrielle Monaco, BS
• Shannon Mong, PSY.D.
• Monroe Avenue Dental
• Elizabeth A. Monson, C.R.N.P.
• Kimberly D. Montagne, FNP
• Frank Leon Montes Jr.
• Megan Montes

• Dentist in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.