Provider Demographics
NPI:1740876853
Name:MARTINEZ, KRYSTEE MARIE (CRDH)
Entity type:Individual
Prefix:
First Name:KRYSTEE
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 NEEDLE PALM DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-6221
Mailing Address - Country:US
Mailing Address - Phone:386-314-3294
Mailing Address - Fax:
Practice Address - Street 1:1119 S DIXIE FWY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA
Practice Address - State:FL
Practice Address - Zip Code:32168-7473
Practice Address - Country:US
Practice Address - Phone:386-428-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26243124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist