Provider Demographics
NPI:1558435537
Name:MARTINEZ, EDMUNDO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 SETTER CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8655
Mailing Address - Country:US
Mailing Address - Phone:336-323-1499
Mailing Address - Fax:336-378-9796
Practice Address - Street 1:1002 N CHURCH ST STE 206
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1448
Practice Address - Country:US
Practice Address - Phone:336-378-9433
Practice Address - Fax:336-378-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics