Provider Demographics
NPI:1669645313
Name:MARTINEZ, MIREILY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIREILY
Middle Name:
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:PO BOX 8044
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8044
Mailing Address - Country:US
Mailing Address - Phone:787-697-1271
Mailing Address - Fax:787-961-5166
Practice Address - Street 1:2E19 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:VILLAS DEL REY SEGUNDA SECCION
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6245
Practice Address - Country:US
Practice Address - Phone:787-697-1271
Practice Address - Fax:787-961-5166
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28131223G0001X
NY0543201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice