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General NPI Number Information
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NPI Number | 1477845113
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Entity Type | Organization
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Legal Business Name | MARTINEZ DENTAL OFFICE
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 2228 W 7TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-4002
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Country | US
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Telephone | 213-381-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 2228 W 7TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-4002
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Country | US
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Telephone | 213-381-7400
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SPEED FRY
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Credential |
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Telephone | 213-381-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20546
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License Number State | CA
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