Provider Demographics
NPI:1639185820
Name:MARTINEZ, DANIEL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 WYOMING BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6018
Mailing Address - Country:US
Mailing Address - Phone:505-881-7337
Mailing Address - Fax:505-881-3972
Practice Address - Street 1:7930 WYOMING BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6018
Practice Address - Country:US
Practice Address - Phone:505-881-7337
Practice Address - Fax:505-881-3972
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice