Provider Demographics
NPI:1013042738
Name:MARTINSON, SHARLENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:
Last Name:MARTINSON
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 1:2531 COLUMBINE LN
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5650
Mailing Address - Country:US
Mailing Address - Phone:970-249-2533
Mailing Address - Fax:970-252-8234
Practice Address - Street 1:816 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3917
Practice Address - Country:US
Practice Address - Phone:970-249-2533
Practice Address - Fax:970-252-8234
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1045101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02045102Medicaid