Provider Demographics
NPI:1760009682
Name:MARTINEZ, SUGUEY (RDH)
Entity Type:Individual
Prefix:MS
First Name:SUGUEY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W LOCKE AVE
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2380
Mailing Address - Country:US
Mailing Address - Phone:870-279-1798
Mailing Address - Fax:
Practice Address - Street 1:104 W LOCKE AVE
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2380
Practice Address - Country:US
Practice Address - Phone:870-279-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2954124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist