Provider Demographics
NPI:1255615977
Name:MARTINEZ, JUAN CARLOS (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
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 1:400 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4406
Mailing Address - Country:US
Mailing Address - Phone:281-342-4530
Mailing Address - Fax:281-344-8615
Practice Address - Street 1:10435 GREENBOUGH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5000
Practice Address - Country:US
Practice Address - Phone:281-261-0182
Practice Address - Fax:281-969-1764
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286302907Medicaid
TX27433OtherLICENSE
TX27433OtherLICENSE