Provider Demographics
NPI:1619453743
Name:MARTINEZ MORALES, LESNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LESNER
Middle Name:
Last Name:MARTINEZ MORALES
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 1:4845 NW 7TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2297
Mailing Address - Country:US
Mailing Address - Phone:832-656-8569
Mailing Address - Fax:
Practice Address - Street 1:4845 NW 7TH ST APT 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2297
Practice Address - Country:US
Practice Address - Phone:832-656-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL236441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice