Provider Demographics
NPI:1124382866
Name:MARTINEZ, AMY MYERS (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MYERS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COPPERFIELD BLVD NE STE 160
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2454
Mailing Address - Country:US
Mailing Address - Phone:704-782-0797
Mailing Address - Fax:
Practice Address - Street 1:1000 COPPERFIELD BLVD NE STE 160
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2454
Practice Address - Country:US
Practice Address - Phone:704-782-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29313122300000X
FLDN209731223G0001X
GADN0144191223G0001X
NC126181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist