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General NPI Number Information
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NPI Number | 1194146498
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Entity Type | Organization
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Legal Business Name | MARTINEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1060 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-3730
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Country | US
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Telephone | 909-373-4600
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Fax | 909-373-4900
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Provider Business Mailing Address
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Address Line | 1060 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-3730
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Country | US
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Telephone | 909-373-4600
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Fax | 909-373-4900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACKQUELINE M MARTINEZ
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Credential | DDS
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Telephone | 909-556-2820
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41955
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License Number State | CA
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