Provider Demographics
NPI:1366866055
Name:GENTER, CYNTHIA MARTINEZ (RDH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARTINEZ
Last Name:GENTER
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 1:13364 SAVANNA
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9143
Mailing Address - Country:US
Mailing Address - Phone:714-717-8001
Mailing Address - Fax:
Practice Address - Street 1:13364 SAVANNA
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-9143
Practice Address - Country:US
Practice Address - Phone:714-717-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24538124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist