Provider Demographics
NPI:1538401419
Name:MARTIN, ALISA LOUISE (DDS)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:LOUISE
Last Name:MARTIN
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 1:952 N. CHERRY ST.
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274
Mailing Address - Country:US
Mailing Address - Phone:559-686-0044
Mailing Address - Fax:559-686-3602
Practice Address - Street 1:952 N. CHERRY ST.
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274
Practice Address - Country:US
Practice Address - Phone:559-686-0044
Practice Address - Fax:559-686-0044
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA581961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice