Provider Demographics
NPI:1326744533
Name:MARTINEZ, EDEYANIRA ALEXIS (RDH)
Entity Type:Individual
Prefix:
First Name:EDEYANIRA
Middle Name:ALEXIS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ECHO RUN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7423
Mailing Address - Country:US
Mailing Address - Phone:970-668-4040
Mailing Address - Fax:
Practice Address - Street 1:41 ECHO RUN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7423
Practice Address - Country:US
Practice Address - Phone:970-389-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024778124Q00000X
CA964124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist