Provider Demographics
NPI:1245901917
Name:MARTINEZ, LAUREL (DMD, AM)
Entity type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DMD, AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 FALLING LEAF ALY
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 FALLING LEAF ALY
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4524
Practice Address - Country:US
Practice Address - Phone:626-447-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073701223E0200X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Yes1223E0200XDental ProvidersDentistEndodontics