Provider Demographics
NPI:1659695617
Name:AMARE, MARTHA (DDS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:AMARE
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 1:2810 CROW CANYON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1670
Mailing Address - Country:US
Mailing Address - Phone:925-743-4170
Mailing Address - Fax:925-473-4167
Practice Address - Street 1:2810 CROW CANYON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1670
Practice Address - Country:US
Practice Address - Phone:925-743-4170
Practice Address - Fax:925-473-4167
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice