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General NPI Number Information
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NPI Number | 1851830806
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Entity Type | Organization
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Legal Business Name | MARTINEZ ORTHODONTICS, PC
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 4469 COLUMBIA RD STE B
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City | MARTINEZ
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State | GA
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Zip | 30907-4573
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Country | US
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Telephone | 706-860-5884
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Fax | 706-860-2100
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Provider Business Mailing Address
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Address Line | 4469 COLUMBIA RD STE B
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City | MARTINEZ
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State | GA
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Zip | 30907-4573
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Country | US
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Telephone | 706-860-5884
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Fax | 706-860-2100
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARBARA JEAN UTERMARK
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Credential | DMD
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Telephone | 706-860-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 8593
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License Number State | GA
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