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General NPI Number Information
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NPI Number | 1700347812
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Entity Type | Individual
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Provider Name | AMMERA KAING MARTIN DDS
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 5401 ARNOLD AVE # 88
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City | MCCLELLAN
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State | CA
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Zip | 95652-1018
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Country | US
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Telephone | 209-242-1311
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Fax |
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Provider Business Mailing Address
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Address Line | 1890 JUNCTION BLVD APT 2324
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City | ROSEVILLE
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State | CA
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Zip | 95747-4703
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Country | US
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Telephone | 209-242-1311
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS103355
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License Number State | CA
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