Provider Demographics
NPI:1346825247
Name:AUTRAN MARTINEZ, JORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:AUTRAN 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:CIRUGIA ORAL Y MAXILOFACIAL
Mailing Address - Street 2:PO BOX 365067
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-751-0858
Practice Address - Street 1:ASEM Y HOSPITAL UNIVERSITARIO DE ADULTOS
Practice Address - Street 2:CENTRO MEDICO DE PR, BO. MONACILLOS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR059-R390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program