Provider Demographics
NPI:1588039929
Name:MARTINEZ & ZERMENO III, A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:MARTINEZ & ZERMENO III, A PROFESSIONAL DENTAL CORP
Other - Org Name:LATIN AMERICAN DENTAL OFFICE III
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-469-6967
Mailing Address - Street 1:407 E GILBERT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5325
Mailing Address - Country:US
Mailing Address - Phone:909-885-7000
Mailing Address - Fax:909-885-7008
Practice Address - Street 1:407 E GILBERT ST STE 5
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5325
Practice Address - Country:US
Practice Address - Phone:909-885-7000
Practice Address - Fax:909-885-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty