Provider Demographics
NPI:1982392445
Name:MARTINEZ HERNANDEZ, ELSA MARY (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:MARY
Last Name:MARTINEZ HERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18240 MEDITERRANEAN BLVD APT 1105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5721
Mailing Address - Country:US
Mailing Address - Phone:786-203-9706
Mailing Address - Fax:
Practice Address - Street 1:2555 COLLINS AVE # C3
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4723
Practice Address - Country:US
Practice Address - Phone:305-672-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39020000X1041S0200X
FL27960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool