Provider Demographics
NPI:1790824894
Name:MARTIR, ROWENA S (DMD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:S
Last Name:MARTIR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8976 FOOTHILL BLVD STE B9
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3400
Mailing Address - Country:US
Mailing Address - Phone:909-476-0070
Mailing Address - Fax:909-476-0080
Practice Address - Street 1:8976 FOOTHILL BLVD STE B9
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3400
Practice Address - Country:US
Practice Address - Phone:909-476-0070
Practice Address - Fax:909-476-0080
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice