Provider Demographics
NPI:1740166149
Name:MARTINEZ CANON, MONICA VIVIANA (DDS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:VIVIANA
Last Name:MARTINEZ CANON
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 1:743 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4525
Mailing Address - Country:US
Mailing Address - Phone:817-821-6637
Mailing Address - Fax:
Practice Address - Street 1:2055 N PERRIS BLVD STE E12
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2518
Practice Address - Country:US
Practice Address - Phone:951-657-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist