Healthcare Provider Details

I. General information

NPI: 1598398513
Provider Name (Legal Business Name): CALIFORNIA DENTAL SLEEP SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 BLOSSOM HILL RD STE E7
SAN JOSE CA
95123-2701
US

IV. Provider business mailing address

827 BLOSSOM HILL RD STE E7
SAN JOSE CA
95123-2701
US

V. Phone/Fax

Practice location:
  • Phone: 408-212-5252
  • Fax:
Mailing address:
  • Phone: 408-212-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JACLYN COLETTE MARTINEZ
Title or Position: OWNER
Credential: DDS
Phone: 408-307-0053