Provider Demographics
NPI:1194863076
Name:MARTINEZ, EDMUNDO MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:MANUEL
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 1:4302 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4109
Mailing Address - Country:US
Mailing Address - Phone:956-687-8065
Mailing Address - Fax:956-687-1457
Practice Address - Street 1:4302 N 23RD ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4109
Practice Address - Country:US
Practice Address - Phone:956-687-8065
Practice Address - Fax:956-687-1457
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice