Provider Demographics
NPI:1376713362
Name:MARTINEAU DENTISTRY PLLC
Entity Type:Organization
Organization Name:MARTINEAU DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-975-3933
Mailing Address - Street 1:13761 N LITCHFIELD RD. SUITE 103
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:623-975-3933
Mailing Address - Fax:623-975-3493
Practice Address - Street 1:13761 N LITCHFIELD RD. SUITE 103
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-975-3933
Practice Address - Fax:623-975-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD61121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty