Provider Demographics
NPI:1609868561
Name:MARTINEZ, JOSEPH DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
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 1:904 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2024
Mailing Address - Country:US
Mailing Address - Phone:541-963-3525
Mailing Address - Fax:541-963-8008
Practice Address - Street 1:904 6TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2024
Practice Address - Country:US
Practice Address - Phone:541-963-3525
Practice Address - Fax:541-963-8008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD 53951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics