MEDICARE: JESUS E MARTINEZ DDS DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1386322733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESUS E MARTINEZ DDS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	5467 MORENO ST STE A
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1682
Country	:	US
Telephone Number	:	909-602-1816
Fax Number	:

Provider Business Practice Location Address
First Line	:	5467 MORENO ST STE A
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1682
Country	:	US
Telephone Number	:	909-602-1816
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESUS MARTINEZ
Credential	:	DDS
Telephone Number	:	818-984-3996

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/13/2023

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