Provider Demographics
NPI:1699465609
Name:MARTINEZ, BRANDON JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JOSEPH
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4024
Mailing Address - Country:US
Mailing Address - Phone:919-830-8735
Mailing Address - Fax:
Practice Address - Street 1:5231 UNIVERSITY PKWY UNIT 120
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3009
Practice Address - Country:US
Practice Address - Phone:941-363-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice