Provider Demographics
NPI:1396184156
Name:MARTINEZ, JUAN JOSE (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
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 1:2811 AIRLINE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1151
Mailing Address - Country:US
Mailing Address - Phone:832-834-4200
Mailing Address - Fax:832-201-8825
Practice Address - Street 1:4102 TREE MOSS PL
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4499
Practice Address - Country:US
Practice Address - Phone:832-274-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist