Provider Demographics
NPI:1083094155
Name:MARTINEZ, COREY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:D
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 1:10445 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1436
Mailing Address - Country:US
Mailing Address - Phone:317-846-3431
Mailing Address - Fax:
Practice Address - Street 1:2204 S PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8059
Practice Address - Country:US
Practice Address - Phone:765-724-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012410A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist