Provider Demographics
NPI:1669498382
Name:MARTINEZ, IVETTE MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:MARIA
Last Name:MARTINEZ
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 1:131 AVE DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3501
Mailing Address - Country:US
Mailing Address - Phone:787-754-2270
Mailing Address - Fax:787-754-6231
Practice Address - Street 1:131 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3501
Practice Address - Country:US
Practice Address - Phone:787-754-2270
Practice Address - Fax:787-754-6231
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice