Provider Demographics
NPI:1093925133
Name:MARTINEZ, MARIO JOSE (DDS)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:JOSE
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 1:6601 SW 80TH ST
Mailing Address - Street 2:STE. 212
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4661
Mailing Address - Country:US
Mailing Address - Phone:305-666-2068
Mailing Address - Fax:305-666-0612
Practice Address - Street 1:6601 SW 80TH ST
Practice Address - Street 2:STE. 212
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4661
Practice Address - Country:US
Practice Address - Phone:305-666-2068
Practice Address - Fax:305-666-0612
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 152051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry