Provider Demographics
NPI:1164499315
Name:MARTINEZ, REYES (DDS)
Entity Type:Individual
Prefix:DR
First Name:REYES
Middle Name:
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:PO BOX 70012
Mailing Address - Street 2:PMB 1171
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-0666
Mailing Address - Fax:787-863-0861
Practice Address - Street 1:STATE ROAD NO.3 CARIBBEAN CINEMAS BUILDING
Practice Address - Street 2:SUITE 202
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-0666
Practice Address - Fax:787-863-0861
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice