Provider Demographics
NPI:1710075999
Name:MARTINEZ, KRISTINA S
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:S
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5374 COX SMITH RD STE C
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9289
Mailing Address - Country:US
Mailing Address - Phone:513-229-8609
Mailing Address - Fax:513-229-8607
Practice Address - Street 1:5374 COX SMITH RD STE C
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9289
Practice Address - Country:US
Practice Address - Phone:513-229-8609
Practice Address - Fax:513-229-8607
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist