Provider Demographics
NPI:1013025287
Name:MARTINEZ, SHELLY SLOVAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:SLOVAK
Last Name:MARTINEZ
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 1:2501 PAREDES LINE RD STE B3
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1195
Mailing Address - Country:US
Mailing Address - Phone:956-542-9200
Mailing Address - Fax:
Practice Address - Street 1:2501 PAREDES LINE RD STE B3
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1195
Practice Address - Country:US
Practice Address - Phone:956-542-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151128901Medicaid
TXB20613-1OtherTX CHIP PROGRAM ID
TX36-4564648OtherPA TAX ID
TX151128902Medicaid
TX172064101Medicaid