Provider Demographics
NPI:1184083677
Name:JAZMIN MARTINEZ
Entity type:Organization
Organization Name:JAZMIN MARTINEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:01152656-406-8503
Mailing Address - Street 1:TOMAS ALBA EDISON # 969
Mailing Address - Street 2:
Mailing Address - City:JUAREZ
Mailing Address - State:CHIHUAHUA
Mailing Address - Zip Code:32300
Mailing Address - Country:MX
Mailing Address - Phone:01152656-406-8503
Mailing Address - Fax:
Practice Address - Street 1:TOMAS ALBA EDISON # 969
Practice Address - Street 2:
Practice Address - City:JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32300
Practice Address - Country:MX
Practice Address - Phone:01152656-406-8503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6172700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty