Healthcare Provider Details

I. General information

NPI: 1740166149
Provider Name (Legal Business Name): MONICA VIVIANA MARTINEZ CANON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W TULARE DR
TULARE CA
93274-3424
US

IV. Provider business mailing address

1134 E CARTMILL AVE
TULARE CA
93274-9610
US

V. Phone/Fax

Practice location:
  • Phone: 559-631-4042
  • Fax: 559-556-0083
Mailing address:
  • Phone: 817-821-6637
  • Fax: 559-556-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: