Provider Demographics
NPI:1609585835
Name:MARTIN DUARTE
Entity Type:Organization
Organization Name:MARTIN DUARTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-102-2012
Mailing Address - Street 1:2275 N CALLE RIVAS
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-3371
Mailing Address - Country:US
Mailing Address - Phone:631-102-2012
Mailing Address - Fax:
Practice Address - Street 1:PIERSON 86 D AVE OBREGON
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:SONORA
Practice Address - Zip Code:84030
Practice Address - Country:MX
Practice Address - Phone:631-102-2012
Practice Address - Fax:619-329-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty