Provider Demographics
NPI:1073572996
Name:MOTA-MARTINEZ, MERCEDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:MOTA-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 1:10401 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2327
Mailing Address - Country:US
Mailing Address - Phone:718-779-2214
Mailing Address - Fax:
Practice Address - Street 1:10401 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2327
Practice Address - Country:US
Practice Address - Phone:718-779-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0405401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178770Medicaid
NY00998187Medicaid