Provider Demographics
NPI:1851369524
Name:MARTINEZ, VINCENT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 W INA ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741
Mailing Address - Country:US
Mailing Address - Phone:520-742-9500
Mailing Address - Fax:520-877-9800
Practice Address - Street 1:2934 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2110
Practice Address - Country:US
Practice Address - Phone:520-742-9500
Practice Address - Fax:520-877-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80580Medicaid