Provider Demographics
NPI:1346753274
Name:MARTINEZ, ADAM MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MATTHEW
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 1:1143 CREEK KNL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5386
Mailing Address - Country:US
Mailing Address - Phone:956-451-8526
Mailing Address - Fax:
Practice Address - Street 1:1431 PALO ALTO ROAD
Practice Address - Street 2:104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-7821
Practice Address - Country:US
Practice Address - Phone:210-446-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice