Provider Demographics
NPI:1912349523
Name:GARCIA CARCELES, MARTINA (DDS)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:GARCIA CARCELES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 1ST ST
Mailing Address - Street 2:APT 6307
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7214
Mailing Address - Country:US
Mailing Address - Phone:781-780-1310
Mailing Address - Fax:
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-9832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist