Provider Demographics
NPI:1740405471
Name:MARTINEZ, JOSEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEAN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:STE 504
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5026
Mailing Address - Country:US
Mailing Address - Phone:787-777-6701
Mailing Address - Fax:787-777-6703
Practice Address - Street 1:735 AVE. PONCE DE LEON TORRE DEL AUXILIO MUTUO
Practice Address - Street 2:SUITE 504
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-607-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist