Provider Demographics
NPI:1265002489
Name:MARTIN, YANNELYS (DMD)
Entity Type:Individual
Prefix:
First Name:YANNELYS
Middle Name:
Last Name:MARTIN
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 1:1760 NW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3432
Mailing Address - Country:US
Mailing Address - Phone:305-798-3370
Mailing Address - Fax:
Practice Address - Street 1:1673 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2046
Practice Address - Country:US
Practice Address - Phone:305-642-6330
Practice Address - Fax:305-649-3692
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN261531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice