Provider Demographics
NPI:1962514448
Name:MARTINEZ, MIGUEL (DMD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:ANGEL
Other - Last Name:MARTINEZ-DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:505 N. PIEDRAS STREET
Mailing Address - Street 2:ATTN MS LAURA PORTER
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-568-5935
Mailing Address - Fax:915-568-5174
Practice Address - Street 1:505 N. PIEDRAS STREET
Practice Address - Street 2:ATTN MS LAURA PORTER
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-568-5935
Practice Address - Fax:915-568-5174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2713122300000X
TX254271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist