Provider Demographics
NPI:1578777454
Name:MARTINEZ, JESUS EDWARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:EDWARDO
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 1:885 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5953
Mailing Address - Country:US
Mailing Address - Phone:951-845-1829
Mailing Address - Fax:951-845-1829
Practice Address - Street 1:885 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-5953
Practice Address - Country:US
Practice Address - Phone:951-845-1829
Practice Address - Fax:951-845-1829
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice