Provider Demographics
NPI:1497958664
Name:MIQUEO, MARTHA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:B
Last Name:MIQUEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SYLVAN AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2525
Mailing Address - Country:US
Mailing Address - Phone:201-816-4000
Mailing Address - Fax:201-816-1114
Practice Address - Street 1:300 SYLVAN AVE FL 3
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2525
Practice Address - Country:US
Practice Address - Phone:201-816-4000
Practice Address - Fax:201-816-1114
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017910001223P0221X
NJ061341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry