Provider Demographics
NPI:1003812041
Name:MARTENSON, JILL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:MARTENSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1019
Mailing Address - Country:US
Mailing Address - Phone:510-652-2911
Mailing Address - Fax:510-652-0772
Practice Address - Street 1:1331 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1019
Practice Address - Country:US
Practice Address - Phone:510-652-2911
Practice Address - Fax:510-652-0772
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist