1932310331 NPI number — DR. LYNNE DIAN MARTZ DDS

Table of content: DR. LYNNE DIAN MARTZ DDS (NPI 1932310331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932310331 NPI number — DR. LYNNE DIAN MARTZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTZ
Provider First Name:
LYNNE
Provider Middle Name:
DIAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARSHALL
Provider Other First Name:
LYNNE
Provider Other Middle Name:
DIAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932310331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2067 YGNACIO VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-934-1211
Provider Business Mailing Address Fax Number:
925-934-9309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2067 YGNACIO VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-934-1211
Provider Business Practice Location Address Fax Number:
925-934-9309
Provider Enumeration Date:
05/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  35761 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)