Provider Demographics
NPI:1700936903
Name:MARTINEZ, ALBERTO LUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:LUIS
Last Name:MARTINEZ
Suffix:
Gender:M
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:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1337
Mailing Address - Country:US
Mailing Address - Phone:787-292-8140
Mailing Address - Fax:787-292-2703
Practice Address - Street 1:ROAD 848 KM 0.3
Practice Address - Street 2:ALTOS CORREO ST JUST
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-292-8140
Practice Address - Fax:787-292-2703
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice