Provider Demographics
NPI:1114566734
Name:CENDEJAS, MARTHA VIVIAN (RDH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:VIVIAN
Last Name:CENDEJAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:VIVIAN
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5638 RATTLESNAKE SPRINGS RD # UBITB
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-4108
Mailing Address - Country:US
Mailing Address - Phone:915-479-1775
Mailing Address - Fax:
Practice Address - Street 1:1515 NE LAWRIE TATUM RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-3099
Practice Address - Country:US
Practice Address - Phone:580-354-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024704124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist