Provider Demographics
NPI:1215220108
Name:MARTINEZ, KENIA D
Entity type:Individual
Prefix:DR
First Name:KENIA
Middle Name:D
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 NORTH AVE
Mailing Address - Street 2:APT I
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2573
Mailing Address - Country:US
Mailing Address - Phone:646-290-1571
Mailing Address - Fax:
Practice Address - Street 1:110 E 40TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-682-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50056193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist