Provider Demographics
NPI:1336264597
Name:MARTZ, SOPHIA K (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:K
Last Name:MARTZ
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 1:66 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1517
Mailing Address - Country:US
Mailing Address - Phone:978-526-0077
Mailing Address - Fax:
Practice Address - Street 1:66 SUMMER ST.
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1517
Practice Address - Country:US
Practice Address - Phone:978-526-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice