Provider Demographics
NPI:1073869996
Name:NUNES, MARTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:NUNES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 W PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2228
Mailing Address - Country:US
Mailing Address - Phone:972-745-7745
Mailing Address - Fax:972-745-3166
Practice Address - Street 1:188 W PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2228
Practice Address - Country:US
Practice Address - Phone:972-745-7745
Practice Address - Fax:972-745-3166
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28304122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist