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General NPI Number Information
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NPI Number | 1386898963
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Entity Type | Individual
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Provider Name | MARTIN G MARTZ D.D.S., M.S,
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Gender | Male
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE. UCLA DEPARTMENT OF ORTHODONTICS MD 12-334
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City | LOS ANGELES
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State | CA
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Zip | 90095-1752
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Country | US
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Telephone | 310-825-5161
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Fax | 310-206-4921
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE. UCLA DEPARTMENT OF ORTHODONTICS MD 12-334
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City | LOS ANGELES
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State | CA
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Zip | 90095-1752
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Country | US
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Telephone | 310-825-5651
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Fax | 310-206-4921
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 26203
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License Number State | CA
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