Provider Demographics
NPI:1851075154
Name:MARTINOLICH, MARTHA BEATRIZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:BEATRIZ
Last Name:MARTINOLICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 S BROAD ST APT 707
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1064
Mailing Address - Country:US
Mailing Address - Phone:786-665-0758
Mailing Address - Fax:
Practice Address - Street 1:320 EVESBORO MEDFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-5733
Practice Address - Country:US
Practice Address - Phone:856-334-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02979700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist