Provider Demographics
NPI:1588798169
Name:MARTINEZ, JIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:
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 1:3445 S DEMAREE ST STE A
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7013
Mailing Address - Country:US
Mailing Address - Phone:559-733-4478
Mailing Address - Fax:559-733-4480
Practice Address - Street 1:3445 S DEMAREE ST STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7013
Practice Address - Country:US
Practice Address - Phone:559-733-4478
Practice Address - Fax:559-733-4480
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice