Provider Demographics
NPI:1740468362
Name:KERZIE, MARTIN LUKE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LUKE
Last Name:KERZIE
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 1:4970 ROCKLIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3336
Mailing Address - Country:US
Mailing Address - Phone:916-871-8673
Mailing Address - Fax:916-797-2140
Practice Address - Street 1:4970 ROCKLIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3336
Practice Address - Country:US
Practice Address - Phone:916-871-8673
Practice Address - Fax:916-797-2140
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice