Provider Demographics
NPI:1427210582
Name:MARTIN, MARTHA EUGENIA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:EUGENIA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 CHATHAM PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6573
Mailing Address - Country:US
Mailing Address - Phone:925-642-3949
Mailing Address - Fax:
Practice Address - Street 1:100 CORTONA WAY
Practice Address - Street 2:SUITE 260
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7124
Practice Address - Country:US
Practice Address - Phone:925-420-6850
Practice Address - Fax:925-684-4998
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice