Provider Demographics
NPI:1902932429
Name:VANZINA, MARTHA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:G
Last Name:VANZINA
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 1:511 BYRON ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2007
Mailing Address - Country:US
Mailing Address - Phone:650-323-1381
Mailing Address - Fax:650-323-7857
Practice Address - Street 1:511 BYRON ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2007
Practice Address - Country:US
Practice Address - Phone:650-323-1381
Practice Address - Fax:650-323-7857
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist