Provider Demographics
NPI:1306100920
Name:EDUARDO MARTINEZ DMD PA
Entity type:Organization
Organization Name:EDUARDO MARTINEZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-281-6604
Mailing Address - Street 1:8050 NW 10TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2865
Mailing Address - Country:US
Mailing Address - Phone:786-281-6604
Mailing Address - Fax:
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-551-0176
Practice Address - Fax:305-551-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 183591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty