MEDICARE: MR. RIGO MARTIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	47126	CA

General Provider Information

NPI Number	:	1598804619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RIGO MARTIN DDS

Provider Business Mailing Address
First Line	:	5201 DEER VALLEY ROAD
Second Line	:	SUITE 3C
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7429
Country	:	US
Telephone Number	:	925-757-4204
Fax Number	:	925-757-2178

Provider Business Practice Location Address
First Line	:	5201 DEER VALLEY ROAD
Second Line	:	SUITE 3C
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7429
Country	:	US
Telephone Number	:	925-757-4204
Fax Number	:	925-757-2178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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