Provider Demographics
NPI:1083820310
Name:MARTINEZ, ANNIE H (DDS)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:H
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 1:932 RED RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4630
Mailing Address - Country:US
Mailing Address - Phone:201-836-0454
Mailing Address - Fax:
Practice Address - Street 1:251 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1961
Practice Address - Country:US
Practice Address - Phone:973-478-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01397100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist