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General NPI Number Information
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NPI Number | 1740166149
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Entity Type | Individual
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Provider Name | MONICA VIVIANA MARTINEZ CANON DDS
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Gender | Female
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 2055 N PERRIS BLVD STE E12
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City | PERRIS
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State | CA
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Zip | 92571-2518
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Country | US
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Telephone | 951-657-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 743 LEXINGTON AVE
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City | COPPELL
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State | TX
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Zip | 75019-4525
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Country | US
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Telephone | 817-821-6637
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 111922
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License Number State | CA
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