Provider Demographics
NPI:1346326972
Name:MARTINEZ, MILTON FERNANDO (DMD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:FERNANDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SW 11TH ST
Mailing Address - Street 2:APT 1427
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4143
Mailing Address - Country:US
Mailing Address - Phone:305-915-0600
Mailing Address - Fax:
Practice Address - Street 1:17301 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33056-4001
Practice Address - Country:US
Practice Address - Phone:305-624-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice