Provider Demographics
NPI:1629118716
Name:MARTINI, CAITILIN RENEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAITILIN
Middle Name:RENEE
Last Name:MARTINI
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 1:3502 W BAY TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7045
Mailing Address - Country:US
Mailing Address - Phone:813-839-6999
Mailing Address - Fax:813-831-1670
Practice Address - Street 1:3502 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7045
Practice Address - Country:US
Practice Address - Phone:813-839-6999
Practice Address - Fax:813-831-1670
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013463332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies