Provider Demographics
NPI:1598398513
Name:CALIFORNIA DENTAL SLEEP SOLUTIONS
Entity Type:Organization
Organization Name:CALIFORNIA DENTAL SLEEP SOLUTIONS
Other - Org Name:CALIFORNIA DENTAL SLEEP SOLUTIONS, JACLYN MARTINEZ DDS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:COLETTE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-307-0053
Mailing Address - Street 1:827 BLOSSOM HILL RD STE E7
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2701
Mailing Address - Country:US
Mailing Address - Phone:408-212-5252
Mailing Address - Fax:
Practice Address - Street 1:827 BLOSSOM HILL RD STE E7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2701
Practice Address - Country:US
Practice Address - Phone:408-212-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty