Provider Demographics
NPI:1386172708
Name:MARTINEZ, COLTON BUC (DDS)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:BUC
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 1:95 S 100 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3001
Mailing Address - Country:US
Mailing Address - Phone:435-637-4545
Mailing Address - Fax:435-637-4546
Practice Address - Street 1:95 S 100 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3001
Practice Address - Country:US
Practice Address - Phone:435-637-4545
Practice Address - Fax:435-637-4546
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10391483-9922122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist