Provider Demographics
NPI:1770005290
Name:MARTINEZ, FELICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 LUNA DEL ORO CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1646
Mailing Address - Country:US
Mailing Address - Phone:505-270-5309
Mailing Address - Fax:
Practice Address - Street 1:8401 OSUNA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2074
Practice Address - Country:US
Practice Address - Phone:505-294-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD47451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice