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General NPI Number Information
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NPI Number | 1104231562
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Entity Type | Individual
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Provider Name | ZACHARY MARTINEAU DMD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 1809 W STATE STREET SUITE B3
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City | PLEASANT GROVE
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State | UT
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Zip | 84062
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Country | US
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Telephone | 385-269-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 1809 W STATE STREET SUITE B3
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City | PLEASANT GROVE
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State | UT
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Zip | 84062
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Country | US
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Telephone | 385-269-0550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 107791679922
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License Number State | UT
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