Provider Demographics
NPI:1598599151
Name:MARTINEZ, GLADYS (RDH)
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 W COLLEGE AVE APT 3245
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4894
Mailing Address - Country:US
Mailing Address - Phone:707-295-0090
Mailing Address - Fax:
Practice Address - Street 1:5900 STATE FARM DR FL 2
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2149
Practice Address - Country:US
Practice Address - Phone:707-559-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36680124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist