Organization
IVAN MEDINA-MARTINEZ DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN ALEJANDRO MEDINA-MARTINEZ DDS (PRESIDENT)
(661) 437-6877
Entity
Organization
Contact information
Practice address
2122 BRUNDAGE LN, BAKERSFIELD, CA 93304-2702
(661) 437-6877
(661) 349-9980
Mailing address
3403 WILSON RD, BAKERSFIELD, CA 93309-5208
(661) 489-0678
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
102012
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102012
CALIFORNIA DENTAL BOARD
CA
01
—
1114436854
NPI TYPE 1
CA
Enumeration date
06/07/2018
Last updated
03/07/2023
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