Healthcare Provider Details

I. General information

NPI: 1851837595
Provider Name (Legal Business Name): DANIEL MARTINEZ-TOVAR RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL MARTINEZ RDH

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SW DURHAM RD BUILDING 710
TIGARD OR
97224-5539
US

IV. Provider business mailing address

PO BOX 568
CORNELIUS OR
97113-0568
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-5775
  • Fax: 503-431-5776
Mailing address:
  • Phone: 503-352-8657
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: