Provider Demographics
NPI:1649396367
Name:MARTINEZ ARCHILLA, CARLOS J
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:MARTINEZ ARCHILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 AVE LA CEIBA
Mailing Address - Street 2:ROVIRA OFFICE PARK SUITE 101
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1902
Mailing Address - Country:US
Mailing Address - Phone:787-844-7500
Mailing Address - Fax:787-844-7880
Practice Address - Street 1:623 AVE LA CEIBA
Practice Address - Street 2:ROVIRA OFFICE PARK, SUITE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1902
Practice Address - Country:US
Practice Address - Phone:787-844-7500
Practice Address - Fax:787-844-7880
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22261223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry