Provider Demographics
NPI:1083777361
Name:MARTINEZ, CHRISTIE LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYNN
Last Name:MARTINEZ
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 1:10299 SCRIPPS TRL
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2366
Mailing Address - Country:US
Mailing Address - Phone:858-578-0277
Mailing Address - Fax:858-578-0389
Practice Address - Street 1:10299 SCRIPPS TRL
Practice Address - Street 2:SUITE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2366
Practice Address - Country:US
Practice Address - Phone:858-578-0277
Practice Address - Fax:858-578-0389
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice