Provider Demographics
NPI:1073780672
Name:MARTINEZ, EFREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:
Last Name:MARTINEZ
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 1:1200 S WADSWORTH BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5434
Mailing Address - Country:US
Mailing Address - Phone:303-733-7533
Mailing Address - Fax:303-733-9826
Practice Address - Street 1:1200 S WADSWORTH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5434
Practice Address - Country:US
Practice Address - Phone:303-733-7533
Practice Address - Fax:303-733-9826
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO105802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02058022Medicaid