Provider Demographics
NPI:1932709987
Name:MARTIN, RUBEN DARIO JR
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:DARIO
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 T C JESTER BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3278
Mailing Address - Country:US
Mailing Address - Phone:786-830-8979
Mailing Address - Fax:
Practice Address - Street 1:791 TOWN AND COUNTRY BLVD STE 222
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3978
Practice Address - Country:US
Practice Address - Phone:832-742-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL14578122400000X
TX402321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122400000XDental ProvidersDenturist