Provider Demographics
NPI:1366728123
Name:ITURRIAGA, MARTHA LOUISANA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LOUISANA
Last Name:ITURRIAGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S WHITE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3812
Mailing Address - Country:US
Mailing Address - Phone:408-259-2214
Mailing Address - Fax:408-259-2695
Practice Address - Street 1:1000 S WHITE RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3812
Practice Address - Country:US
Practice Address - Phone:408-259-2214
Practice Address - Fax:408-259-2695
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist