Provider Demographics
NPI:1639907454
Name:FRIAS-MARTINEZ, JOSE A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:FRIAS-MARTINEZ
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 CALLE CESAR GONZALEZ STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3757
Mailing Address - Country:US
Mailing Address - Phone:787-341-6682
Mailing Address - Fax:
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 301
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3757
Practice Address - Country:US
Practice Address - Phone:787-341-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist