Provider Demographics
NPI:1124114905
Name:MARTINEZ, SHERRI ANN (DMD)
Entity type:Individual
Prefix:
First Name:SHERRI ANN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:BURGONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:9515 GAINEY RANCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8019
Mailing Address - Country:US
Mailing Address - Phone:702-341-0701
Mailing Address - Fax:
Practice Address - Street 1:2801 S VALLEY VW
Practice Address - Street 2:STE 4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0116
Practice Address - Country:US
Practice Address - Phone:702-385-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69721223G0001X
NV56391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice