Healthcare Provider Details

I. General information

NPI: 1457235806
Provider Name (Legal Business Name): DALIA VILLA MARTINEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 REYNOLDS RANCH PKWY STREET 100
LODI CA
95240
US

IV. Provider business mailing address

2610 REYNOLDS RANCH PKWY STREET 100
LODI CA
95240
US

V. Phone/Fax

Practice location:
  • Phone: 209-693-0105
  • Fax:
Mailing address:
  • Phone: 209-693-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: