Provider Demographics
NPI:1578975264
Name:MARTOS, GRISEL (DMD)
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:
Last Name:MARTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 NW 42ND AVE
Mailing Address - Street 2:633
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5541
Mailing Address - Country:US
Mailing Address - Phone:305-448-3896
Mailing Address - Fax:305-442-2225
Practice Address - Street 1:782 NW 42ND AVE
Practice Address - Street 2:633
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5541
Practice Address - Country:US
Practice Address - Phone:305-448-3896
Practice Address - Fax:305-442-2225
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist