Provider Demographics
NPI:1558188763
Name:SAN DIMAS FAMILY AND SEDATION DENTISTRY
Entity type:Organization
Organization Name:SAN DIMAS FAMILY AND SEDATION DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-305-2300
Mailing Address - Street 1:319 N SAN DIMAS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2658
Mailing Address - Country:US
Mailing Address - Phone:909-305-2300
Mailing Address - Fax:
Practice Address - Street 1:319 N SAN DIMAS AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2658
Practice Address - Country:US
Practice Address - Phone:909-305-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental