Provider Demographics
NPI:1952926263
Name:PARRA MARTINEZ, GEORGINA (DDS)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:PARRA MARTINEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21105 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3319
Mailing Address - Country:US
Mailing Address - Phone:949-633-9530
Mailing Address - Fax:
Practice Address - Street 1:2097 COMPTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7289
Practice Address - Country:US
Practice Address - Phone:951-273-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002052041223G0001X
CA390200000X
CA1100941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program