Healthcare Provider Details

I. General information

NPI: 1821086570
Provider Name (Legal Business Name): JOANNE SUAREZ MARTINEZ D.D.S.,
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26711 ALISO CREEK RD SUITE 200-C
ALISO VIEJO CA
92656-4820
US

IV. Provider business mailing address

26711 ALISO CREEK RD SUITE 200-C
ALISO VIEJO CA
92656-4820
US

V. Phone/Fax

Practice location:
  • Phone: 949-349-0303
  • Fax: 949-349-0664
Mailing address:
  • Phone: 949-349-0303
  • Fax: 949-349-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number44445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: