Provider Demographics
NPI:1790963577
Name:PARROQUIN, MARTHA PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:PATRICIA
Last Name:PARROQUIN
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 1:12632 WELBY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1212
Mailing Address - Country:US
Mailing Address - Phone:626-960-9966
Mailing Address - Fax:626-962-9136
Practice Address - Street 1:12632 WELBY WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1212
Practice Address - Country:US
Practice Address - Phone:626-960-9966
Practice Address - Fax:626-962-9136
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice