| Ivan Medina-martinez Dds, Inc. | |
|
2122 Brundage Ln Bakersfield CA 93304-2702 | |
| (661) 437-6877 | |
| (661) 349-9980 |
| Full Name | Ivan Medina-martinez Dds, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2122 Brundage Ln, Bakersfield, California |
| Authorized Official Name and Position | Ivan Alejandro Medina-martinez (PRESIDENT) |
| Authorized Official Contact | 6614376877 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivan Medina-martinez Dds, Inc. 3403 Wilson Rd Bakersfield CA 93309-5208 Ph: (661) 489-0678 | Ivan Medina-martinez Dds, Inc. 2122 Brundage Ln Bakersfield CA 93304-2702 Ph: (661) 437-6877 |
| NPI Number | 1467945212 |
|---|---|
| Provider Enumeration Date | 06/07/2018 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467945212 | NPI | - | NPPES |
| 102012 | Other | CA | CALIFORNIA DENTAL BOARD |
| 1114436854 | Other | CA | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 102012 (California) | Primary |
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