Provider Demographics
NPI:1073667580
Name:MICHELLE A DEMARTA DMD INC
Entity Type:Organization
Organization Name:MICHELLE A DEMARTA DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:DEMARTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-321-7270
Mailing Address - Street 1:703 WELCH ROAD
Mailing Address - Street 2:SUITE D6
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-321-7270
Mailing Address - Fax:650-322-1500
Practice Address - Street 1:703 WELCH ROAD
Practice Address - Street 2:SUITE D6
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-321-7270
Practice Address - Fax:650-322-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty