Provider Demographics
NPI:1295747251
Name:MARTINEZ, SUSIVIEN CUNANAN (DMD)
Entity type:Individual
Prefix:MRS
First Name:SUSIVIEN
Middle Name:CUNANAN
Last Name:MARTINEZ
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 1:32483 HIGHWAY 79 SOUTH
Mailing Address - Street 2:STE E119
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-303-1399
Mailing Address - Fax:951-303-3537
Practice Address - Street 1:32483 HIGHWAY 79 SOUTH
Practice Address - Street 2:STE E119
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-303-1399
Practice Address - Fax:951-303-3537
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist