Provider Demographics
NPI:1851962773
Name:MARTINEZ, AMY DAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DAWN
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 1:10310 MUSTANG RDG
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2462
Mailing Address - Country:US
Mailing Address - Phone:210-900-0721
Mailing Address - Fax:
Practice Address - Street 1:608 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1304
Practice Address - Country:US
Practice Address - Phone:210-336-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist