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General NPI Number Information
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NPI Number | 1114566734
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Entity Type | Individual
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Provider Name | MARTHA VIVIAN CENDEJAS RDH
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Gender | Female
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Dates
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Enumeration Date | 12/30/2019
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3099
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Country | US
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Telephone | 580-354-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 5638 RATTLESNAKE SPRINGS RD # UBITB
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City | EL PASO
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State | TX
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Zip | 79906-4108
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Country | US
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Telephone | 915-479-1775
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.002024704
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License Number State | CO
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