Provider Demographics
NPI:1245605740
Name:MELINA MARTINEZ DMD LLC
Entity Type:Organization
Organization Name:MELINA MARTINEZ DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:LUJAN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-983-1312
Mailing Address - Street 1:2010 BOTULPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5730
Mailing Address - Country:US
Mailing Address - Phone:505-983-1312
Mailing Address - Fax:505-983-8170
Practice Address - Street 1:2010 BOTULPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5730
Practice Address - Country:US
Practice Address - Phone:505-983-1312
Practice Address - Fax:505-983-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty