Healthcare Provider Details

I. General information

NPI: 1659392272
Provider Name (Legal Business Name): TIMOTHY STEVEN MARTINEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PALM CANYON DR # 212
BORREGO SPRINGS CA
92004-4000
US

IV. Provider business mailing address

8657 CAMDEN DR
SANTEE CA
92071-3926
US

V. Phone/Fax

Practice location:
  • Phone: 760-767-5112
  • Fax: 760-767-5613
Mailing address:
  • Phone: 619-873-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16633
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS58323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: