Provider Demographics
NPI:1346094695
Name:MARTINEZ, MILDRED (DMD)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:MARTINEZ
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 1:3333 NORTHLAKE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1717
Mailing Address - Country:US
Mailing Address - Phone:954-861-9072
Mailing Address - Fax:
Practice Address - Street 1:3333 NORTHLAKE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1717
Practice Address - Country:US
Practice Address - Phone:561-776-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty