Provider Demographics
NPI:1508208851
Name:MARTINEZ, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N AKARD ST
Mailing Address - Street 2:#2021
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5204 S COLONY BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2347
Practice Address - Country:US
Practice Address - Phone:469-656-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist