Healthcare Provider Details

I. General information

NPI: 1245901917
Provider Name (Legal Business Name): LAUREL MARTINEZ DMD, AM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 LOCUST ST STE 200
PASADENA CA
91101-4457
US

IV. Provider business mailing address

747 LOCUST ST STE 200
PASADENA CA
91101-4457
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-5361
  • Fax:
Mailing address:
  • Phone: 626-796-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number107370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: