Provider Demographics
NPI:1629418488
Name:MARTENS, JESSICA CERVANTES (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CERVANTES
Last Name:MARTENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2052
Mailing Address - Country:US
Mailing Address - Phone:712-263-5615
Mailing Address - Fax:712-263-8124
Practice Address - Street 1:1415 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2052
Practice Address - Country:US
Practice Address - Phone:712-263-5615
Practice Address - Fax:712-263-8124
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice