Provider Demographics
NPI:1598804619
Name:MARTIN, RIGO (DDS)
Entity Type:Individual
Prefix:MR
First Name:RIGO
Middle Name:
Last Name:MARTIN
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 1:5201 DEER VALLEY ROAD
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7429
Mailing Address - Country:US
Mailing Address - Phone:925-757-4204
Mailing Address - Fax:925-757-2178
Practice Address - Street 1:5201 DEER VALLEY ROAD
Practice Address - Street 2:SUITE 3C
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7429
Practice Address - Country:US
Practice Address - Phone:925-757-4204
Practice Address - Fax:925-757-2178
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist