Provider Demographics
NPI:1376094698
Name:WILLIAM T MARTEY DMD MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WILLIAM T MARTEY DMD MD A PROFESSIONAL CORPORATION
Other - Org Name:DENTAL SPA OF ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARTEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:714-282-2525
Mailing Address - Street 1:2291 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3703
Mailing Address - Country:US
Mailing Address - Phone:714-282-2525
Mailing Address - Fax:
Practice Address - Street 1:2291 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3703
Practice Address - Country:US
Practice Address - Phone:714-282-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366655987Medicare UPIN