Provider Demographics
NPI:1780881961
Name:TIMOTHY S MARTINEZ, PC
Entity type:Organization
Organization Name:TIMOTHY S MARTINEZ, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-349-6300
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:SOUTH WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02663-0700
Mailing Address - Country:US
Mailing Address - Phone:508-349-6300
Mailing Address - Fax:508-349-6385
Practice Address - Street 1:CANNON HILL RD AT RTE. 6
Practice Address - Street 2:
Practice Address - City:SOUTH WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02663
Practice Address - Country:US
Practice Address - Phone:508-349-6300
Practice Address - Fax:508-349-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty