Provider Demographics
NPI:1518207554
Name:MARTINEAU, JACOB WADE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:WADE
Last Name:MARTINEAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 N HIGHWAY 89 STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6257
Mailing Address - Country:US
Mailing Address - Phone:801-737-5437
Mailing Address - Fax:
Practice Address - Street 1:2719 N HIGHWAY 89 STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-6257
Practice Address - Country:US
Practice Address - Phone:801-737-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT93980171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry