Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 43817 | CA |
NPI | 1003812041 |
---|---|
Provider Name | Dr. Jill Ann Martenson |
First Address | Piedmont, CA 94610-1019 |
Second Address | Piedmont, CA 94610-1019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 04/02/2014 |