Provider Demographics
NPI:1184903569
Name:SCHELLINCK, MARTIN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LEE
Last Name:SCHELLINCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5279
Mailing Address - Country:US
Mailing Address - Phone:925-300-3619
Mailing Address - Fax:925-300-3854
Practice Address - Street 1:1855 SAN MIGUEL DR
Practice Address - Street 2:SUITE 14
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5279
Practice Address - Country:US
Practice Address - Phone:925-300-3619
Practice Address - Fax:925-300-3854
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA621931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics