Provider Demographics
NPI:1225126253
Name:MARTINEZ, NORMAN PETRONIO SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:PETRONIO
Last Name:MARTINEZ
Suffix:SR
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 1:2907 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1810
Mailing Address - Country:US
Mailing Address - Phone:618-466-5508
Mailing Address - Fax:
Practice Address - Street 1:2907 GODFREY RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1810
Practice Address - Country:US
Practice Address - Phone:618-466-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry