Provider Demographics
NPI:1184936346
Name:MARTINEZ, VICKIE S (DDS)
Entity type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:S
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 1:3715 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3514
Mailing Address - Country:US
Mailing Address - Phone:210-532-1166
Mailing Address - Fax:210-388-1841
Practice Address - Street 1:3715 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3514
Practice Address - Country:US
Practice Address - Phone:210-532-1166
Practice Address - Fax:210-388-1841
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist