| Organization Name: | KENNETH R, MARTI DDS INC. |
| NPI Number: | 1093931396 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH R. MARTI (OWNER) |
| Mailing Address: | 6049 Douglas Blvd Suite 9 Granite Bay |
| State: | CA US |
| Postal Code: | 957466284 |
| Phone Number: | 9167914133 |
| Fax Number: | 9167911659 |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 27453 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |