Provider Demographics
NPI:1699199836
Name:MARTINEZ, CRYSTAL (RDA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4865 HEDGCOXE RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2406
Mailing Address - Country:US
Mailing Address - Phone:972-505-2210
Mailing Address - Fax:972-505-2212
Practice Address - Street 1:4865 HEDGCOXE RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2406
Practice Address - Country:US
Practice Address - Phone:972-505-2210
Practice Address - Fax:972-505-2212
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38099126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant