Healthcare Provider Details

I. General information

NPI: 1851830806
Provider Name (Legal Business Name): MARTINEZ ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 COLUMBIA RD STE B
MARTINEZ GA
30907-4573
US

IV. Provider business mailing address

4469 COLUMBIA RD STE B
MARTINEZ GA
30907-4573
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-5884
  • Fax: 706-860-2100
Mailing address:
  • Phone: 706-860-5884
  • Fax: 706-860-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number8593
License Number StateGA

VIII. Authorized Official

Name: DR. BARBARA JEAN UTERMARK
Title or Position: PRESIDENT
Credential: DMD
Phone: 706-860-5884