Provider Demographics
NPI:1245516020
Name:MARTHA L ITURRIAGA D.D.S INC
Entity type:Organization
Organization Name:MARTHA L ITURRIAGA D.D.S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LOUISANA
Authorized Official - Last Name:ITURRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-259-2214
Mailing Address - Street 1:1000 S WHITE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3812
Mailing Address - Country:US
Mailing Address - Phone:408-910-5725
Mailing Address - Fax:
Practice Address - Street 1:1000 S WHITE RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3812
Practice Address - Country:US
Practice Address - Phone:408-259-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty