Provider Demographics
NPI:1093059123
Name:ROVIRA, MARTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:ROVIRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7783
Mailing Address - Country:US
Mailing Address - Phone:949-640-1122
Mailing Address - Fax:
Practice Address - Street 1:1401 AVOCADO AVE STE 404
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7783
Practice Address - Country:US
Practice Address - Phone:949-640-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist