Provider Demographics
NPI:1700948049
Name:MARTINEZ, HECTOR LEE (DDS)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:LEE
Last Name:MARTINEZ
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 1:125 ASCOT DR STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3408
Mailing Address - Country:US
Mailing Address - Phone:916-791-8834
Mailing Address - Fax:916-791-6634
Practice Address - Street 1:125 ASCOT DR STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3408
Practice Address - Country:US
Practice Address - Phone:916-791-8834
Practice Address - Fax:916-791-6634
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA843134OtherINITED CONCORDIA