Healthcare Provider Details

I. General information

NPI: 1962956227
Provider Name (Legal Business Name): MARTINA ASSAD D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22430 VAN BUREN BLVD STE 200
RIVERSIDE CA
92518-2709
US

IV. Provider business mailing address

22430 VAN BUREN BLVD STE 200
RIVERSIDE CA
92518-2709
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-0151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: