Provider Demographics
NPI:1295872497
Name:MARTIN, VICTOR ALBANO (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ALBANO
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 SANTA ANITA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2458
Mailing Address - Country:US
Mailing Address - Phone:626-401-9808
Mailing Address - Fax:714-996-0258
Practice Address - Street 1:3564 SANTA ANITA AVE STE F
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2458
Practice Address - Country:US
Practice Address - Phone:626-401-9808
Practice Address - Fax:714-996-0258
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice