Provider Demographics
NPI:1376713230
Name:MARTINEZ, MARIO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
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 1:4550 CHERRY CREEK SOUTH DR APT 501
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1540
Mailing Address - Country:US
Mailing Address - Phone:303-338-8181
Mailing Address - Fax:303-752-2568
Practice Address - Street 1:3488 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4531
Practice Address - Country:US
Practice Address - Phone:303-338-8181
Practice Address - Fax:303-752-2568
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist