Provider Demographics
NPI:1497241574
Name:MARTINEZ, LESTER DIAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:DIAZ
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4515
Mailing Address - Country:US
Mailing Address - Phone:408-680-3442
Mailing Address - Fax:
Practice Address - Street 1:29632 HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:ROUND MOUNTAIN
Practice Address - State:CA
Practice Address - Zip Code:96084
Practice Address - Country:US
Practice Address - Phone:530-337-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist