Provider Demographics
NPI:1518424761
Name:MARTINEZ LEON, IGNACIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:
Last Name:MARTINEZ LEON
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 1:10615 SW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2860
Mailing Address - Country:US
Mailing Address - Phone:305-934-7247
Mailing Address - Fax:
Practice Address - Street 1:168 SE 1ST ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1403
Practice Address - Country:US
Practice Address - Phone:305-372-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN251111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice