Provider Demographics
NPI:1851595490
Name:ROBLES MARTINEZ, MARIO E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:ROBLES MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 51185
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PR
Mailing Address - Zip Code:00950
Mailing Address - Country:US
Mailing Address - Phone:787-272-0152
Mailing Address - Fax:787-272-0150
Practice Address - Street 1:AVE APOLO A-2 ALTO APOLO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-272-0152
Practice Address - Fax:787-272-0150
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41219OtherBLUE CROSS PR
9500040OtherHUMANA
206779OtherREFERRED HEALTH
3626OtherFIRST MEDICAL
PR41152OtherSSS