Provider Demographics
NPI:1265954341
Name:MARTZ, RYAN D (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:MARTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BERNERI DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-4642
Mailing Address - Country:US
Mailing Address - Phone:480-577-8264
Mailing Address - Fax:
Practice Address - Street 1:2345 E CENTENNIAL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-5605
Practice Address - Country:US
Practice Address - Phone:702-766-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice