Provider Demographics
NPI:1659596989
Name:MARTINEZ, DANIEL LEVI (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEVI
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 1:1733 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SECURITY
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1150
Mailing Address - Country:US
Mailing Address - Phone:719-390-4946
Mailing Address - Fax:719-390-4947
Practice Address - Street 1:1733 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SECURITY
Practice Address - State:CO
Practice Address - Zip Code:80911-1150
Practice Address - Country:US
Practice Address - Phone:719-390-4946
Practice Address - Fax:719-390-4947
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104692DENTIST122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist