Provider Demographics
NPI:1982365623
Name:MARTINEZ DENTISTRY INDIANAPOLIS
Entity Type:Organization
Organization Name:MARTINEZ DENTISTRY INDIANAPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-671-5066
Mailing Address - Street 1:10455 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1436
Mailing Address - Country:US
Mailing Address - Phone:317-343-8853
Mailing Address - Fax:
Practice Address - Street 1:10455 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46280-1436
Practice Address - Country:US
Practice Address - Phone:317-343-8853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental