Healthcare Provider Details

I. General information

NPI: 1508131376
Provider Name (Legal Business Name): IRMA PEREZ MARTINEZ DMD MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 JAMES WAY SUITE 201
PISMO BEACH CA
93449-4973
US

IV. Provider business mailing address

PO BOX 2752
PASO ROBLES CA
93447-2752
US

V. Phone/Fax

Practice location:
  • Phone: 805-773-1600
  • Fax:
Mailing address:
  • Phone: 805-773-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateCA

VIII. Authorized Official

Name: IRMA PEREZ MARTINEZ
Title or Position: PRESIDENT
Credential: DMD
Phone: 805-773-1600