Provider Demographics
NPI:1811235609
Name:RGV FAMILY DENTISTRY BY LUZ E MARTINEZ DDS PLLC
Entity Type:Organization
Organization Name:RGV FAMILY DENTISTRY BY LUZ E MARTINEZ DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-968-3300
Mailing Address - Street 1:909 JAMES STREET
Mailing Address - Street 2:SUITE G
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-968-3300
Mailing Address - Fax:956-968-3306
Practice Address - Street 1:909 JAMES STREET
Practice Address - Street 2:SUITE G
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-968-3300
Practice Address - Fax:956-968-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073832069Medicaid