Provider Demographics
NPI:1912047523
Name:ARMIJO, MARTY (DDS, PC)
Entity Type:Individual
Prefix:
First Name:MARTY
Middle Name:
Last Name:ARMIJO
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 COORS BLVD NW STE K6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2776
Mailing Address - Country:US
Mailing Address - Phone:505-897-7740
Mailing Address - Fax:505-899-7519
Practice Address - Street 1:6100 COORS BLVD NW STE K6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2776
Practice Address - Country:US
Practice Address - Phone:505-897-7740
Practice Address - Fax:505-899-7519
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice