Provider Demographics
NPI:1346825247
Name:AUTRAN MARTINEZ, JORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:AUTRAN MARTINEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1571
Mailing Address - Country:US
Mailing Address - Phone:586-301-9519
Mailing Address - Fax:
Practice Address - Street 1:30671 STEPHENSON HWY STE F
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1653
Practice Address - Country:US
Practice Address - Phone:313-466-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016023441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery