Provider Demographics
NPI:1003224023
Name:MORETT, MARTHA ELVA (DDS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELVA
Last Name:MORETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ELVA
Other - Last Name:MORETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:807 CAMINO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2810
Mailing Address - Country:US
Mailing Address - Phone:858-766-1168
Mailing Address - Fax:619-435-6847
Practice Address - Street 1:1203 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1430
Practice Address - Country:US
Practice Address - Phone:619-435-6840
Practice Address - Fax:619-435-6847
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist