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General NPI Number Information
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NPI Number | 1588039929
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Entity Type | Organization
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Legal Business Name | MARTINEZ & ZERMENO III, A PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 407 E GILBERT ST STE 5
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5325
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Country | US
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Telephone | 909-885-7000
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Fax | 909-885-7008
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Provider Business Mailing Address
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Address Line | 407 E GILBERT ST STE 5
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5325
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Country | US
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Telephone | 909-885-7000
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Fax | 909-885-7008
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Authorized Official
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Title or Position | CEO-PRESIDENT
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Name | GABRIEL G. MARTINEZ
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Credential | DDS
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Telephone | 909-469-6967
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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 | 46886
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License Number State | CA
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