Provider Demographics
NPI:1154577302
Name:MARTINEZ, MONICA ALEJANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ALEJANDRA
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 1:2501 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-5104
Mailing Address - Country:US
Mailing Address - Phone:516-652-6372
Mailing Address - Fax:
Practice Address - Street 1:303 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3600
Practice Address - Country:US
Practice Address - Phone:516-431-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist