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General NPI Number Information
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NPI Number | 1467945212
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Entity Type | Organization
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Legal Business Name | IVAN MEDINA-MARTINEZ DDS, INC.
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2122 BRUNDAGE LN
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City | BAKERSFIELD
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State | CA
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Zip | 93304-2702
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Country | US
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Telephone | 661-437-6877
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Fax | 661-349-9980
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Provider Business Mailing Address
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Address Line | 3403 WILSON RD
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City | BAKERSFIELD
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State | CA
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Zip | 93309-5208
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Country | US
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Telephone | 661-489-0678
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN ALEJANDRO MEDINA-MARTINEZ
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Credential | DDS
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Telephone | 661-437-6877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 102012
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License Number State | CA
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