Provider Demographics
NPI:1447618244
Name:MARTINEZ ORTHODONTICS LLC
Entity Type:Organization
Organization Name:MARTINEZ ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:702-979-9799
Mailing Address - Street 1:5775 S RAINBOW BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2530
Mailing Address - Country:US
Mailing Address - Phone:702-979-9799
Mailing Address - Fax:702-979-9823
Practice Address - Street 1:5775 S RAINBOW BLVD
Practice Address - Street 2:STE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2530
Practice Address - Country:US
Practice Address - Phone:702-979-9799
Practice Address - Fax:702-979-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-2561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty