Provider Demographics
NPI:1053754572
Name:LINCER, CAROL B (RDH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:LINCER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:B
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9775 NE BLACKCAP LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7116
Mailing Address - Country:US
Mailing Address - Phone:510-672-1229
Mailing Address - Fax:
Practice Address - Street 1:9775 NE BLACKCAP LN
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7116
Practice Address - Country:US
Practice Address - Phone:510-672-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 26847124Q00000X
ORH6399124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist