Provider Demographics
NPI:1881727717
Name:MARTINEZ, TAMARA TATIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:TATIANA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 N STATE ROAD 7
Mailing Address - Street 2:SUITE #24
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7008
Mailing Address - Country:US
Mailing Address - Phone:954-979-1357
Mailing Address - Fax:954-979-0763
Practice Address - Street 1:3207 N STATE ROAD 7
Practice Address - Street 2:SUITE #24
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7008
Practice Address - Country:US
Practice Address - Phone:954-979-1357
Practice Address - Fax:954-979-0763
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice