Provider Demographics
NPI:1518905314
Name:MARTINEZ, JESUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 SW 88TH ST
Mailing Address - Street 2:SUITE 249
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1515
Mailing Address - Country:US
Mailing Address - Phone:305-552-0402
Mailing Address - Fax:786-542-8880
Practice Address - Street 1:13500 SW 88TH ST
Practice Address - Street 2:SUITE 249
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1515
Practice Address - Country:US
Practice Address - Phone:305-552-0402
Practice Address - Fax:786-542-8880
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-155271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL188614OtherFACILITY NUMBER
FL188614OtherFACILITY NUMBER